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Disclosures: Schwarze reports receiving grants from the Greenwall Foundation and the NIH, and that her spouse has ownership interest outside the study. Kalbfell, Kapadia and the study authors report no relevant financial disclosures.
April 07, 2021
2 min read
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Patients favor surgeons wearing clear masks during procedures

Disclosures: Schwarze reports receiving grants from the Greenwall Foundation and the NIH, and that her spouse has ownership interest outside the study. Kalbfell, Kapadia and the study authors report no relevant financial disclosures.
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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.

Ian Kratzke, MD — one of the study authors — demonstrates the use of a normal mask vs. a clear mask. Photo source: University of North Carolina School of Medicine.
Ian Kratzke, MD — one of the study authors — demonstrates the use of a normal mask vs. a clear mask. Photo source: University of North Carolina School of Medicine.

‘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.