Masking up has become a necessity during the Covid-19 pandemic, but how has that affected communication between surgeons and patients?
According to the results of a randomized clinical trial, patients want to see their surgeons’ faces. And when surgeons wear a clear mask, patients give them high marks for providing understandable explanations, demonstrating empathy, and eliciting trust.
The study, led by Ian M. Kratzke, MD, Department of Surgery, University of North Carolina, Chapel Hill, was published in JAMA Surgery.
“Communication is at the heart of the surgeon-patient relationship and crucial for developing trust, explaining complex concepts, and engaging patients in shared decision-making while accounting for their expectations and concerns,” explained Kratzke and colleagues. However, they also pointed out that with the onset of the Covid-19 pandemic, mask wearing has become a potential barrier to effective communication.
The authors hypothesized that the use of clear masks would improve patient perceptions of surgeon communication. Therefore, in this study they randomized surgeons to wear either standard covered masks or clear masks in order to evaluate how that would impact patient perceptions and affect communication in a surgical setting.
This trial enrolled 200 patients from 15 surgeons’ clinics involving 7 subspecialties, with surgeons wearing either clear masks (ASTM level 3, equivalent to the standard surgical masks) or covered masks for each clinic visit with a new patient, based on a per-visit randomization plan. Patients were excluded from the study if they were deemed high risk and N95 respirator use recommended.
The main outcomes of the trial included perceptions of surgeon communication, trust in surgeons, and quantitative/qualitative assessments regarding patient impressions of the surgeon’s mask.
The study showed that patients responded more favorably when surgeons wore a clear mask. Specifically, when surgeons wore a clear mask, patients rated them higher for providing understandable explanations (clear, 95 of 100 [95%] vs covered, 78 of 100 [78%]) and demonstrating empathy (clear, 99 [99%] vs covered, 85 [85%]), and patients had higher trust in their decision making (clear, 94 [94%] vs covered, 72 [72%]).
When asked about their impressions of mask wearing, patients whose surgeon wore a clear mask unanimously gave it a positive rating, compared to just 72% of patients whose surgeons wore covered masks.
Despite the positive responses from patients, when surgeons were asked how likely they are to choose masks in the future, less than half (47%) responded favorably (a score of 3 or 4 on a 4-point Likert scale where 1 was low likelihood, and 4 a high likelihood). About a quarter of surgeons reported their likelihood of choosing a clear mask would be higher based on patient preference, while several surgeons voiced concerns about the level of protection from clear masks.
The findings suggest that mask wearing could undermine patient trust, understanding, and their perception of physician empathy. “These findings should alert surgeons, because patient perceptions may not be detectable without purposeful attention to communication,” wrote Kratzke and colleagues. “We must make every effort to protect the sacred physician-patient relationship during these unprecedented times.”
They also said efforts should be made to determine whether there are communication behaviors or technologies that can be used to mitigate the adverse effects of covered masks.
In a commentary accompanying the study, Margaret L. Schwarze, MD, and Elle L. Kalbfell, MD, both of the Department of Surgery, University of Wisconsin-Madison, wrote that its results suggest that imparting information from surgeon to client “may not be as important as we think.”
Instead, they suggested it is possible that developing an interpersonal relationship with the surgeon is more critical to a patient than getting technical details about an illness or treatment. The surgical consultation could be relational, as far as the patient is concerned, they added, and “visual cues such as a smile, frown, or other facial gestures likely contributed to patient-perceived rapport and higher ratings despite similar informational content.”
Thus, how surgeons speak to their patients may be as important as what they say, Schwarze and Kalbfell concluded. “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 wrote.
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Surgeons that wear clear masks elicit more trust from their patients and are perceived to be better communicators and more empathetic.
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About half of surgeons, however, are unlikely to choose the clear mask over the standard covered mask.
Michael Bassett, Contributing Writer, BreakingMED™
Schwarze reported grants from the National Institutes of Health and Greenwall Foundation and reports that her spouse has ownership interest outside the submitted work.
Cat ID: 159
Topic ID: 97,159,728,791,932,730,933,192,927,590,928,925,934,159
