Benefits of Clear Masks in Communication With Patients

Adapting to new safety standards during COVID-19 has likely been easier for surgeons who are accustomed to wearing a mask. Although wearing masks outside the operating room has become the new normal, it may not be as easy for patients as it is for us. In this issue of JAMA Surgery, Kratzke et al¹ demonstrate that patients whose surgeon wore a clear mask were significantly more likely to give a top-box rating (4 on a Likert scale of 1-4) for providing easy-to-understand information, knowledge of patient information, displaying empathy, and generating trust.¹ Although there was no significant difference in patient-reported comfort with the surgeon operating on them, it is unclear whether this study was powered to detect such a difference.

This evidence should motivate us to consider why patients reported a striking difference in communication, particularly in a field (clinical communication research) that is chronically hamstrung by measurements with high ceiling effects. Because each surgeon served as their own control, the content of communication about disease and treatment, ie, information and knowledge, was presumably the same in each group. Thus, information transfer may not be as important as we think; technical details about illness or treatment may be less salient for patients than developing an interpersonal connection. Surgeons might view the surgical consultation as transactional, a time to exchange information, but patients may be inclined to see it as relational. Because human expressions are a critical component of emotional exchange, visual cues such as a smile, frown, or other facial gestures likely contributed to patient-perceived rapport and higher ratings despite similar informational content.

The findings may also point to what covered masks lack rather than what clear masks provide. When surgeons wear covered masks, patients may sense a lack of transparency, viewing the mask as a form of disguise or concealment. With limited visual cues, patients are left to determine how the surgeon is thinking or feeling. Many also noted it was easier to hear the surgeon, suggesting compensation for hearing loss or sensory preferences with visual cues. Study findings may also reflect pandemic fatigue. Masks are a reminder of innumerable hardships over the past year, and clear masks represent extra effort by surgeons to mitigate patient discomfort and increase engagement.

Alongside the disastrous effects of COVID-19 on everyday life, do clear masks really matter? They might. Trust is the cornerstone of surgical care. Without it, patients would not let us operate on them or trust our judgment to forgo surgery. And 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.

Corresponding Author: Margaret L. Schwarze, MD, Department of Surgery, University of Wisconsin-Madison, K6/134 CSC, 600 Highland Ave, Madison, WI 53726 (schwarze@surgery.wisc.edu).

Published Online: March 11, 2021. doi:10.1001/jamasurg.2021.0848

Conflict of Interest Disclosures: Dr Schwarze reported grants from the National Institutes of Health and Greenwall Foundation and reports that her spouse has ownership interest outside the submitted work. No other disclosures were reported.