It’s time to greet patients with smiling faces

I APPROACH the coming months with feelings of fear and sadness as it becomes apparent the NHS finds itself ideologically wedded to the wearing of masks for ever more. A decision that appears based solely on emotion and without any clear evidence of benefit over harm. If any institution in the country should be a beacon of decisions made from solid and powerful science, it is the NHS. And yet, here we are. The NHS seems committed to ignoring the first tenet of healthcare; first do no harm.

At the start of the pandemic one could understand emotion being the driver for decisions based on the desire to save lives. A new, previously unseen virus arrived, was clearly dangerous for some, we didn’t understand who was at risk and we needed to keep as many from danger as we could. Wearing a mask seemed like a non-intrusive precaution. Having a 77-year-old mum, I wore a mask in shops when no one else did, I implored others to do so. I was frontline, convinced I would at some point be exposed to this virus and if I could avoid gifting it to my mum, I would do anything that seemed sensible. It was an emotional reaction and one I persevered with for several months. But over time I did what I was trained to do; appraise emerging evidence to see if my hypothesis held – that wearing a mask in the community protected me and others from Covid-19. 

Starting with the science it became clear there were no sound Randomised Controlled Trials (RCT’s) to prove that mask wearing saved lives. Most studies were models, often emanating from China (who were by far the biggest beneficiaries of mask mandates and their continuation) and non-peer-reviewed models at that. All made assumptions about the wearing of the mask; brand new, placed on the face, in the right way and then not touched until disposed of within 4 hours. As time went on bigger studies emerged but they were often plagued by poor science, selection and quality. In fact the biggest RCT from Bangladesh showed that once the two arms were compared, there was a difference of cases between the two groups of just 20. Amongst 500,000 participants it showed masks making no difference. 

So what was going on? Why did the messaging from SAGE, PHE and government only strengthen with time? There has been much speculation, some backed by SAGE members talking off-the-record, and the only answer that has any merit to me is one of signalling. Wearing a mask has two effects; it convinces the wearer that they are in the midst of a very dangerous pandemic and it signals to those around that there is a collective benefit to being part of the crowd. In other words, masks act as no more than signals to maintain fear and mark people out as part of the team working together to beat the enemy, even if it were doing no such thing. Conversely it also by default indicated those who were not ‘part of the team’. The outliers who didn’t wear the uniform that masks have become. It is clear from SAGE minutes very early on that they didn’t think the public were scared enough, they then went about scaring us. Masks perpetuated that fear. 

Masks did much more than this, however, they caused harm – much of it hidden. And this is where my concern for the future really lies. Why are we perpetuating this harm in the NHS when the benefit is at best unproven? It really came home to me this week when I consulted a young suicidal patient in General Practice. Our practice policy is for masks whenever a patient is in the building. I always invite a patient to take their mask off as soon as in my room, but they often forget to invite me to join them. So I stay masked as I don’t want to assume or pressurise. As I tried to console my young patient she kept asking me to repeat myself. I realised it was the mask and took it off, but it made me think of consultations in general, not just that one. 

There is a massive part of the doctor/patient consultation that relies on facial signals, this is all lost. People who are hard of hearing rely on seeing lip movements, babies and toddlers need to see smiling faces for reassurance, the elderly struggle with voices and lips behind masks, children and teenagers feel like they are dangerous transmitters of the virus and are losing their social skills; consulting a teenager and building rapport is tough at the best of times. Patients with mental health issues, anxiety, claustrophobia, breathing difficulties all suffer behind a mask. The list is long. 

We have lectures at medical school teaching us about barriers to consulting, and physical barriers as well as emotional ones must be eradicated wherever possible for optimal outcomes. It isn’t just the desk that is a barrier to good consulting, it is faces hidden behinds masks and they need to go, for the health of the nation going forward. 

And yet we carry on. Why? We have one of the most vaccinated populations on the planet, herd immunity is in the 90’s, omicron has evolved to a cold-like illness that is a serious threat to a tiny minority. Masks are gone everywhere, apart from the NHS and the private providers who follow NHS protocols. Frankly it’s time to ditch them in healthcare too. Obviously not in theatres and ICU where they have always been used for different reasons, but in every single area where they were adopted for Covid. 

It’s time to cut the umbilical cord and for patients to be greeted with smiling faces before we forget that we never consulted whilst wearing masks prior to Covid. It’s time to put the patient first again. 

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Dr Renée Hoenderkamp is an accomplished practising NHS GP working in both practice and A&E. A media writer and presenter, she was the resident GP for BBC Radio London and has a regular show on TALK Radio London, and regularly appears on GB News. She is an author for MailPlus and The Daily Mail and has a special interest in Women’s Health and Menopause. 

Photo of doctors and nurses wearing masks by Rido from Adobe Stock