Lets face it, as face masks have become part of our daily outerwear, the ability to effectively communicate has been disrupted. The nuances and sublteies of nonverbal communication including facial expressions are most at risk, with the potential to result in moments comparable to “lost in translation”.
The reality is that nonverbal cues such as movements of lips and facial muscles (i.e. smiling or grimacing hidden by a standard face mask) can impact our takeaway and impressions of an interaction. And while the eyes are a proverbial “window to the soul”, it may not always be possible to read a person’s emotions and thoughts solely by analyzing their eye movements while wearing a traditional face mask.
With this in mind, maintaining effective communication between healthcare professionals and physicians—in the midst of a barrier such as a face mask—has been an ongoing concern since beginning of the pandemic. Without the ability of patients to see our faces completely, could this ultimately affect patient communication and trust?
Well, a recent JAMA study did just that—exploring whether clear face masks could improve communications between patients and their surgeons. And the results should make all healthcare providers take note.
In a nutshell, the researchers evaluated whether clear face masks (ClearMask) could improve patient-provider communications at a single academic medical center in newly recruited patients. Surgeons wore either a clear mask or a more traditional opaque or covered mask for clinic visits with each new patient. Patients then completed a verbal survey after each visit addressing surgeon empathy, trust, and patients’ impression of the surgeon’s mask.
The randomized trial of 200 patients found that patients who saw surgeons who wore clear masks, compared with those who saw surgeons that wore standard masks, were more inclined to agree that the surgeon explained the situation more clearly (95% vs 78%), demonstrated empathy (99% vs 85%) and engendered trust (94% vs 72%).
"When surgeons wore clear masks as opposed to traditional masks, patients rated their surgeon significantly higher in how well they provided an understandable explanation, knew the patient's history, demonstrated empathy, and built trust," said Ian Kratzke, MD, a resident in the department of Surgery at the UNC School of Medicine, and first author of the study in a press release.
In terms of an intervention to boost “patient experience”—potentially translating to improved outcomes—this is a “clear” win-win for both parties involved. What the study shows is that patients would like to see their surgeon’s face, or as much as possible of it. And when this happens, there is a boost to trust, not to mention empathy, as a result of improved communication delivered by enhanced clarity and understanding of spoken words.
“All things being equal, any intervention that enhances patient-provider communication should be pursued,” said Amesh Adalja, MD, an infectious disease physician, and Senior Scholar at Johns Hopkins Center for Health Security. “Clear masks that are the equivalent in terms of fit and filtration capacity should be an option more widely implemented.”
And while the benefits of clear masks for enhancing speech understanding among deaf and hard of hearing persons are evident, the benefit to patients and medical providers may be invaluable in terms of trust and patient outcomes. In effect, the shift to clear masks could translate to tangible gains such as patients being more likely to follow postoperative instructions or other recommendations—the result of more effective communication from seeing their provider’s face and nonverbal cues.
While wearing clear masks for provider-patient interactions can be a solution, Muneera Kapadia MD, Associate Professor of surgery in the UNC School of Medicine and senior author of the study explained that the study is actually about drawing attention to the importance of facial communication for communication in general.
"Our face is how we connect with other people," said Kapadia. "We react to people with facial cues, which are being covered by the masks, and that's having a big impact on communication."
"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," added Kapadia.
Dr. Joseph Sakran, Director of Emergency General Surgery, and Associate Professor of Surgery at Johns Hopkins, offered that “this unique approach of evaluating communication between patients and surgeons has highlighted once again the critical role that nonverbal communication plays in engaging with our patients.”
“The transmission of messages or signals through a nonverbal platform such as facial expressions turns out be critical not just in the traditional sense of communication, but in the perception of empathy among patients,” explained Sakran.
“While a clear face mask may be unorthodox to what many of us are typically used to wearing, the downsides are minimal to none. And, as the adversity we have faced as a healthcare community this past year has been tremendous, this alternative option of helping bridge the communication gap would be just another way to adapt to the already difficult circumstances as we aim to deliver high quality care for our patients,” he added.
“Because masks will remain part of the healthcare landscape for some time, deliberate attention to preserving communication within the surgeon-patient relationship is warranted,” the authors of the study concluded.
What we may infer from the study is that the capacity to see a full face, which include a medical provider’s nonverbal cues, particularly a smile or other facial expressions, can result in a more empathetic and supportive experience.
For that matter, we should include all types of healthcare providers (not just surgeons) in this context and even extend this approach to the general public, since all communication—especially nonverbal facial cues— truly matters.