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BMC Primary Care
Published in: BMC Primary Care 1/2013

Open Access 01-12-2013 | Research article

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

Authors: Carmen Ka Man Wong, Benjamin Hon Kei Yip, Stewart Mercer, Sian Griffiths, Kenny Kung, Martin Chi-sang Wong, Josette Chor, Samuel Yeung-shan Wong

Published in: BMC Primary Care | Issue 1/2013

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Abstract

Background

There 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.

Method

A 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.

Results

1,030 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).

Conclusion

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.

Clinical trial registration

This 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.
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Literature
1.
Loeb M, Dafoe N, Mahony J, John M, Sarabia A, Glavin V, Webby R, Smieja M, Earn DJ, Chong S, Webb A, Walter SD: Surgical mask vs N95 respirator for preventing influenza among health care workers: A randomized trial. JAMA. 2009, 302 (17): 1865-1871. 10.1001/jama.2009.1466.CrossRefPubMed
2.
Jacobs JL, Ohde S, Takahashi O, Tokuda Y, Omata F, Fukui T: Use of surgical face masks to reduce the incidence of the common cold among health care workers in japan: A randomized controlled trial. Am J Infect Control. 2009, 37 (5): 417-419. 10.1016/j.ajic.2008.11.002.CrossRefPubMed
3.
Cowling BJ, Zhou Y, Ip DK, Leung GM, Aiello AE: Face masks to prevent transmission of influenza virus: A systematic review. Epidemiol Infect. 2010, 138 (4): 449-456. 10.1017/S0950268809991658.CrossRefPubMed
4.
Tang JI, Shakespeare TP, Zhang XJ, Lu JJ, Liang S, Wynne CJ, Mukherjee RK, Back MF: Patient satisfaction with doctor-patient interaction in a radiotherapy centre during the severe acute respiratory syndrome outbreak. Australas Radiol. 2005, 49 (4): 304-311. 10.1111/j.1440-1673.2005.01467.x.CrossRefPubMed
5.
Ong LM, de Haes JC, Hoos AM, Lammes FB: Doctor-patient communication: A review of the literature. Soc Sci Med. 1995, 40 (7): 903-918. 10.1016/0277-9536(94)00155-M.CrossRefPubMed
6.
7.
Stewart M, Brown JB, Boon H, Galajda J, Meredith L, Sangster M: Evidence on patient-doctor communication. Cancer Prev Control. 1999, 3 (1): 25-30.PubMed
8.
Campbell SM, Roland MO, Buetow SA: Defining quality of care. Soc Sci Med. 2000, 51 (11): 1611-1625. 10.1016/S0277-9536(00)00057-5.CrossRefPubMed
9.
Howie JG, Heaney D, Maxwell M: Quality, core values and the general practice consultation: Issues of definition, measurement and delivery. Fam Pract. 2004, 21 (4): 458-468. 10.1093/fampra/cmh419.CrossRefPubMed
10.
11.
Roter DL, Frankel RM, Hall JA, Sluyter D: The expression of emotion through nonverbal behavior in medical visits. mechanisms and outcomes. J Gen Intern Med. 2006, 21 (Suppl 1): S28-S34.CrossRefPubMedPubMedCentral
12.
Beck RS, Daughtridge R, Sloane PD: Physician-patient communication in the primary care office: A systematic review. J Am Board Fam Pract. 2002, 15 (1): 25-38.PubMed
13.
Griffith CH, Wilson JF, Langer S, Haist SA: House staff nonverbal communication skills and standardized patient satisfaction. J Gen Intern Med. 2003, 18 (3): 170-174. 10.1046/j.1525-1497.2003.10506.x.CrossRefPubMedPubMedCentral
14.
Ambady N, Koo J, Rosenthal R, Winograd CH: Physical therapists’ nonverbal communication predicts geriatric patients’ health outcomes. Psychol Aging. 2002, 17 (3): 443-452.CrossRefPubMed
15.
Mast MS: On the importance of nonverbal communication in the physician-patient interaction. Patient Educ Couns. 2007, 67 (3): 315-318. 10.1016/j.pec.2007.03.005.CrossRefPubMed
16.
Hall JA, Harrigan JA, Rosenthal R: Nonverbal behavior in clinician—patient interaction. Appl Prev Psychol. 1995, 4 (1): 21-37. 10.1016/S0962-1849(05)80049-6.CrossRef
17.
Channouf A: Subliminal exposure to facial expressions of emotion and evaluative judgments of advertising messages. Eur Rev Appl Psychol. 2000, 50: 19-23.
18.
Dimberg U, Thunberg M, Elmehed K: Unconscious facial reactions to emotional facial expressions. Psychol Sci. 2000, 11 (1): 86-89. 10.1111/1467-9280.00221.CrossRefPubMed
19.
Bensing J: Doctor-patient communication and the quality of care. Soc Sci Med. 1991, 32 (11): 1301-1310. 10.1016/0277-9536(91)90047-G.CrossRefPubMed
20.
Nightingale SD, Yarnold PR, Greenberg MS: Sympathy, empathy, and physician resource utilization. J Gen Intern Med. 1991, 6 (5): 420-423. 10.1007/BF02598163.CrossRef
21.
Roter DL, Stewart M, Putnam SM, Lipkin M, Stiles W, Inui TS: Communication patterns of primary care physicians. JAMA. 1997, 277 (4): 350-356. 10.1001/jama.1997.03540280088045.CrossRefPubMed
22.
Mercer SW, Jani BD, Maxwell M, Wong SY, Watt GC: Patient enablement requires physician empathy: A cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in scotland. BMC Fam Pract. 2012, 13: 6-10.1186/1471-2296-13-6.CrossRefPubMedPubMedCentral
23.
Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, Jordan J: The impact of patient-centered care on outcomes. J Fam Pract. 2000, 49 (9): 796-804.PubMed
24.
Rakel D, Barrett B, Zhang Z, Hoeft T, Chewning B, Marchand L, Scheder J: Perception of empathy in the therapeutic encounter: Effects on the common cold. Patient Educ Couns. 2011, 85 (3): 390-397. 10.1016/j.pec.2011.01.009.CrossRefPubMedPubMedCentral
25.
Kinmonth AL, Woodcock A, Griffin S, Spiegal N, Campbell MJ: Randomised controlled trial of patient centred care of diabetes in general practice: Impact on current wellbeing and future disease risk. the diabetes care from diagnosis research team. BMJ. 1998, 317 (7167): 1202-1208.CrossRefPubMedPubMedCentral
26.
Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS: Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med. 2011, 86 (3): 359-364. 10.1097/ACM.0b013e3182086fe1.CrossRefPubMed
27.
Mercer SW, Neumann M, Wirtz M, Fitzpatrick B, Vojt G: General practitioner empathy, patient enablement, and patient-reported outcomes in primary care in an area of high socio-economic deprivation in scotland–a pilot prospective study using structural equation modeling. Patient Educ Couns. 2008, 73 (2): 240-245. 10.1016/j.pec.2008.07.022.CrossRefPubMed
28.
Mercer SW, Maxwell M, Heaney D, Watt GC: The consultation and relational empathy (CARE) measure: Development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract. 2004, 21 (6): 699-705. 10.1093/fampra/cmh621.CrossRefPubMed
29.
Mercer SW, McConnachie A, Maxwell M, Heaney D, Watt GC: Relevance and practical use of the consultation and relational empathy (CARE) measure in general practice. Fam Pract. 2005, 22 (3): 328-334. 10.1093/fampra/cmh730.CrossRefPubMed
30.
Mercer SW, Fung CS, Chan FW, Wong FY, Wong SY, Murphy D: The Chinese-version of the CARE measure reliably differentiates between doctors in primary care: A cross-sectional study in Hong Kong. BMC Fam Pract. 2011, 12: 43-10.1186/1471-2296-12-43.CrossRefPubMedPubMedCentral
31.
Fung CS, Hua A, Tam L, Mercer SW: Reliability and validity of the Chinese version of the CARE measure in a primary care setting in Hong Kong. Fam Pract. 2009, 26 (5): 398-406. 10.1093/fampra/cmp044.CrossRefPubMed
32.
Howie JG, Heaney DJ, Maxwell M, Walker JJ, Freeman GK, Rai H: Quality at general practice consultations: Cross sectional survey. BMJ. 1999, 319 (7212): 738-743. 10.1136/bmj.319.7212.738.CrossRefPubMedPubMedCentral
33.
Lam CL, Yuen NY, Mercer SW, Wong W: A pilot study on the validity and reliability of the patient enablement instrument (PEI) in a Chinese population. Fam Pract. 2010, 27 (4): 395-403. 10.1093/fampra/cmq021.CrossRefPubMed
34.
R Development Core Team: R: A language and environment for statistical computing. 2005, Vienna, Austria: R Foundation for Statistical Computing
35.
van der Sande M, Teunis P, Sabel R: Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLoS One. 2008, 3 (7): e2618-10.1371/journal.pone.0002618.CrossRefPubMedPubMedCentral
36.
Neumann M, Wirtz M, Bollschweiler E, Mercer SW, Warm M, Wolf J, Pfaff H: Determinants and patient-reported long-term outcomes of physician empathy in oncology: A structural equation modelling approach. Patient Educ Couns. 2007, 69 (1–3): 63-75.CrossRefPubMed
37.
Rakel DP, Hoeft TJ, Barrett BP, Chewning BA, Craig BM, Niu M: Practitioner empathy and the duration of the common cold. Fam Med. 2009, 41 (7): 494-501.PubMedPubMedCentral
Metadata
Title
Effect of facemasks on empathy and relational continuity: a randomised controlled trial in primary care
Authors
Carmen Ka Man Wong
Benjamin Hon Kei Yip
Stewart Mercer
Sian Griffiths
Kenny Kung
Martin Chi-sang Wong
Josette Chor
Samuel Yeung-shan Wong
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2013
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-14-200

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