5 Ways to Get Your Masked Up Communication Back on Track with Your Patients

By Gerard Johnson, M.S. September 07, 2021

First, let me start by saying that like many of you, I hate wearing face masks. Any given day my team and I will spend about 8 hours in a mask. However, the fact is that masking is going to be the new normal at this point in the medical field for the near future and most likely beyond. They are a critical component of keeping patients and our staff safe. Face masks hamper communication, both verbal (e.g., attenuates speech signals produced by the speaker thus degrading quality of speech) and non-verbally (e.g., eliminates a large part of facial expressions). Our ability to reliably detect or express emotions in facial expressions, information necessary to communicate effectively in everyday interactions, is degraded. Masks muffle our voices and filter out higher pitch sounds like ‘’ss’’ and “the” that are important in the English language and help distinguish one word from the next.

The middle and lower face are noted to be very influential with regards to emotional recognition. Misinterpretation of facial emotions can severely affect doctor-patient and inter-professional communication in healthcare. Masks can have an adverse effect on people being able to differentiate emotions if someone is happy, sad, or angry. I don’t know about you, but as a practice manager, the nonverbal cues from patients, if they’re frowning, crying, smiling, or scowling, can be quite beneficial. Studies have established a negative impact on patient health outcomes when clinician-patient communication is disrupted. We have all experienced the frustration of trying to talk to someone through a mask, giving up, and cutting the conversation short. Those unsaid words could be the difference between a patient having a great experience or a negative patient outcome. Maybe, the patient, exasperated by the hindrance of communication, neglects to mention that they have noticed an increase in floaters or that they suffered blurred vision after hitting their head. Luckily, we can use several simple techniques to get your communication back on track with your patients.

1.  Eye see you  

Frontiers | Effect of Face Masks on Interpersonal Communication During the  COVID-19 Pandemic | Public HealthEye contact shows that you are paying attention to the patients' needs and attentive to their concerns. It is important that you are mindful not to stare as too much eye contact can honestly come off a bit creepy and disconcerting. America’s Next Top Model may have made the turn term “smeyes (smile with your eyes)” famous, but your staff does not have to be auditioning for Tyra Banks to put it to good use.

2.  Let your brows do the talking

I mentioned earlier that people can see your smile through the mask, but you can turn up the volume on that smile by scrunching your eyebrows just slightly when you smile. You can also close your eyes when agreeing and raising eyebrows when opposing something during the conversation. For emotional recognition, the eyebrows may be as influential as the eyes, if not more. Everyone has heard the term you could see the fire in his eyes, but it is the furrowed brow that truly denotes anger and frustration. Ignoring the eyebrows even when talking to someone that you are familiar with can lead to a significant disruption in the recognition of emotions. In fact, studies have found that there is a significantly greater detrimental effect in face recognition in the absence of eyebrows than in the absence of eyes.

3.  Be loud and clear

Communication is not a race. Take your time when speaking. Your speech should be loud enough to be heard and clear enough to be understood. It is also good to remember that it is OK to ask a patient if they could slow down when speaking because you want to make sure you get all the information. I will even say to a patient “can you please give me that date or number 2 digits at a time so that I make sure that I don’t make a mistake.”

4.  Be handy

Before kids learn to talk, they use hand gestures to communicate their wants and needs. They describe the world around them with their little hands. Studies have found that hand gestures are an extremely reliable method of non-verbal communication. That is because, in general, people seem to agree on what basic hand gestures mean across cultures and languages. For example, you can use the words “the fish was this big” and elicit an extremely specific visual of the fish based on how a person is holding their hands to describe the size of a fish.

Gestures can be used to direct a person’s attention to a person, place, or thing. Gestures and miming can provide structure to a conversation, like using your hands when counting numbers, to mimic “2 drops per eye”. Hand gestures can even give clues about emotional state, think the tightly closed fist of frustration or anger.

5.  Mask Fit

The last suggestion is the simplest but most overlooked. Find a mask that fits you properly. Not all masks are made the same. So, order a variety of different fits and styles for your team until everyone finds the best fit for them. If people are not comfortable, they will not wear their masks properly, defeating the entire purpose.

Game Time: Emotional Charades

Now that you know what to do it is time to share this newfound knowledge with your team. A way to teach these techniques to help your team improve their communication skills while wearing their mask is by playing a game of Emotional Charades.

Step 1: Break up into groups of 2-3 staff members

Each player will take turns acting out an emotion.

Step 2: Pick an emotion

Have each person select a slip of paper with an emotion written down, being sure not to show their selection to anyone else.


Happy                 Nervous              Shocked              Angry

Concerned         Frustrated            Confused            Attentive       

Step 3: Round One Time (5 minutes)

Each person takes turns showing their emotions while wearing a mask, not talking, and only using face and hands to show their emotion.

Step 4: Time to Share (10 minutes)

Ask everyone what they learned from the first round. Did they notice any tells or tricks to help them read the other person's emotions? Share these techniques with your team.

Additional Tips: Components of body language

Happiness- corners of eye crinkle

Sad- eyes look droopy

Anger- brow straighten, tight hands and shoulders

Confusion- both brows crinkle briefly

Step 5: Round Two (5 minutes)

Repeat the game this time everyone trying out the new tricks. You can even add a number component such as having each person say phone number or a date of birth to practice technique number 3. After the round ask if anyone noticed an improvement in both their ability to show emotions and read emotions.

Larger Purpose:

Review the importance of communication with your team and how they can use their non-verbal communication and tone to bridge the communication gap created by facemask.

Gerard Johnson, M.S.

Gerard is a writer, trainer, and leader who has worked in healthcare since 2003. He has managed and trained teams in Optometry, Ophthalmology, and Family Medicine. Gerard currently works as a practice manager for a family practice in Atlanta, GA.

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