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.
Highlights
There is limited evidence to support the use of facemasks in preventing infection for primary care professionals
This 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
Summary
There is limited evidence to support the use of facemasks in preventing infection for primary care professionals. There is little proven benefit in the sole use of facemask (without hand washing) to prevent healthcare personnel from contracting infections in randomized control trials [1,2,3], with research conducted during the SARS outbreak suggesting a potential negative impact of infection precaution measures including mask wearing, on the domain of doctors’ empathy of a patient satisfaction questionnaire [4]. Only a few studies have looked at the influence of facial expressions on patient health outcomes [14,19]; eye contact was a strong predictor of a positively rated doctor patient interaction [19], whilst doctors’ distancing behaviour, such as not smiling and looking away was perceived negatively by patients [14]. Facial expressiveness (such as smiling, nodding, frowning) of physical therapists were associated with an improvement in ability to perform activities of daily living and a decrease in confusion for elderly patients [14]
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