Effect of facemasks on empathy and relational continuity: a randomised controlled trial in primary care

Abstract

BackgroundThere is limited evidence to support the use of facemasks in preventing infection for primary care professionals. Negative effects on communication has been suggested when the physician wears a facemask. As communication skills and doctor patient relationship are essential to primary care consultations, the effects of doctor’s facemask wearing were explored.MethodA randomised controlled study was conducted in primary care to explore the effects of doctors wearing facemasks on patients’ perception of doctors’ empathy, patient enablement and patient satisfaction. Primary care doctors were randomized to mask wearing and non mask wearing clinical consultations in public primary care clinics in Hong Kong. Patients’ views were gathered using the Consultation and Relational Empathy (CARE) Measure, Patient Enablement Instrument (PEI) and an overall satisfaction rating scale. The effects of face mask wearing were investigated using multilevel (hierarchical) modelling.Results1,030 patients were randomised to doctor-mask wearing consultations (n = 514) and non mask wearing consultations (n = 516). A significant and negative effect was found in the patients’ perception of the doctors’ empathy (CARE score reduction -0.98, p-value = 0.04). In the more established doctor-patient relationship, the effect of doctors’ mask wearing was more pronounced (CARE score reduction -5.67, p-value = 0.03).ConclusionThis study demonstrates that when doctors wearing a facemask during consultations, this has a significant negative impact on the patient’s perceived empathy and diminish the positive effects of relational continuity. Consideration should be taken in planning appropriate use of facemasks in infectious disease policy for primary care and other healthcare professionals at a national, local or practice level.Clinical trial registrationThis trial was registered on Chinese Clinical Trial Register (ChiCTR). Registration no.: ChiCTR-TTRCC-12002519. URL: http://www.chictr.org/en/proj/show.aspx?proj=3486. Due to administrative error, registration of trial did not take place until after the trial started on 1st August 2011 and registration number was released on 21st September 2012.

A study of special care dental patient preference toward choice of mask and visor use by dental clinicians

“…[4][5][6] In a randomized control trial conducted by Wong et al , over 1,000 patients were surveyed with a significant negative effect shown in terms of communication and empathy. 7 The scientific evidence seems to offer little support in the wearing of masks in infection control, either for the patient or the healthcare professional' s sake. In procedures creating aerosols, an "effective" mask would need to be worn for 30 minutes after the procedure to offer any safety benefit.…”

“…In a randomized control trial conducted by Wong et al. , over 1,000 patients were surveyed with a significant negative effect shown in terms of communication and empathy …”

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“…Patient's perceived resistance to non-verbal communication due to the use of masks is an influence on closeness with the doctor. Research by Wong et al found that the use of masks by doctors during consultations had a negative impact on the empathy of doctors and reduced the positive effects of relationships that had been established sustainably 10 .…”