Where Science Meets Instructional Design

Interpersonal communication while wearing a face mask

By Andrew J. Jones, MD, Medical Writer

The COVID-19 pandemic has changed our world. A majority of institutions are now relying on remote working or learning, which has been a significant adjustment for most people. New York City has started the early phases of reopening, and there are scores of people in my Queens neighborhood out and about to soak up the summer sun. But one thing is noticeable: about 95% of them are wearing face masks. For someone like me, who relies on facial cues to understand the motivations of those around me, the use of masks presents a challenge. It’s difficult for me to interact with other people when we’re all wearing masks. Trust me. I used to be a surgeon, and surgeons have been dealing with it for years.

A large body of research has been dedicated to the role of facial expressions in human communication. Humans tend to rely on a combination of facial features, most prominently the eyes and mouth, in order to convey their emotions and messages. So what happens when we take the lower half of the face out of the equation?

The subtraction of nose, mouth, and cheeks is likely to take some more adjustment in the western world. There are a number of populations globally that veil the face for religious or cultural reasons, and surgical or cloth face masks have been worn in several East Asian countries since the early 20th century. The 1918 flu pandemic was devastating for much of the world, and face masks were commonly worn around the globe. This was followed in Japan by the Great Kanto Earthquake of 1923, which led to massive firestorms and the presence of thick smoke and ash in the air that lasted for months. Singapore and Hong Kong dealt with flu pandemics in the 1950s and 1960s, and the SARS outbreak of the early 2000s was particularly worrisome for mainland China, Hong Kong, and Taiwan. Wearing a face mask became a cultural sign of respect and a social contract toward others.

In the operating room (OR), a face mask is required once the sterile instruments and supplies are opened. From that point on, verbal communication and body language are paramount. If you have ever worked in an OR, you are likely aware that not everyone is particularly adept at expressing themselves through words. This can lead to frustration (and the oft heard, “Not like that! Like this!”) among the team when one of them feels something is not being adequately explained. My best surgical teachers were the ones who were truly great at verbal communication. One concrete example of this is the use of anatomical terms like superior, inferior, lateral, and medial rather than saying, “grab below me” or “take some of that next to where you are.” Using the right words at the right time significantly improved my ability to get better and to learn, which helped me become a better team member in the OR.

Can we take this lesson and apply it to life outside of the OR? I believe that the social practice of wearing face masks is an opportunity for all of us to improve our verbal communication skills. Let us commit to one another that we will learn to be more descriptive in how we converse. We can apply this commitment in all facets of our lives, from our workplace interactions to our relationships with family and friends. Perhaps, the widespread use of face masks will usher in a new age of understanding that transcends culture and prejudice. Perhaps, we will become a species that learns to articulate and listen.

Special mention should be made for the hearing impaired who rely on lip reading. Instructions for making a face mask with a transparent shield can be found through this volunteer site based in Belgium.

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