Patients and general practitioners agree that wearing masks during consultations complicates physician--patient relationships: An exploratory, qualitative study

BACKGROUND: The physician--patient relationship plays a critical role in the quality of primary care management. The generalised wearing of surgical masks in enclosed spaces – common during the COVID-19 pandemic -- could change the communication between patients and healthcare professionals. OBJECTIVES: To assess how general practitioners (GPs) and patients feel about wearing masks during a consultation and its influences on physician--patient relationship. To evaluate methods healthcare professionals could use to compensate for mask wearing during a consultation. METHODS: A qualitative study using semi-structured interviews based on a literature-based interview guide with GPs and patients in Brittany, France. Recruitment took place from January to October 2021 until data saturation. Two independent investigators performed an open and thematic coding and then discussed their results with a consensus procedure. RESULTS: Thirteen GPs and 11 patients were included. It appears that wearing masks complicates consultations by creating distance, impairing communication, mainly non-verbal and altering relationship quality. However, GPs and patients believed relationships were preserved, especially those with a solid foundation prior to the pandemic. GPs described having to adapt to maintain relationship. Patients worried about misunderstandings or diagnostic errors but saw the mask as a protective factor. GPs and patients described similar populations requiring vigilance, including geriatric and paediatric populations, and people with hearing impairments or learning difficulties. According to GPs, possible adaptations include speaking clearly, exaggerating non-verbal communication, temporarily removing mask while maintaining safe distance and identifying patients who need increased vigilance. CONCLUSION: Wearing masks makes the doctor--patient relationship more complex. GPs adjusted their practice to compensate.