Is It OK for Internists to Wear Masks Forever?

If you can’t believe we are still talking about this, that is sort of the point of the post. Personally, I could not wait to put mask wearing behind me, but I still find the issue of masking in healthcare facilities interesting. I have written my own essays about it on Sensible Medicine on September 28^th, 2022, and January 11^th, 2024. The parallels to universal precautions, the balance of comfort, communication, and patient safety, and the issues of power in the doctor patient relationship keeps me coming back to the issue. When Dr. Sarkisian emailed me about a recent experience, I asked if she would expand her thoughts to an article. I am happy she did.

Adam Cifu

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I think most people agree that, in 2024, if a patient asks his/her doctor to wear a mask the doctor should do it. But what if patients prefer that their doctors don’t wear masks in settings that we never did before March 2020?  Maybe the patients are hard of hearing or just want to be able to read our expressions. Maybe they feel masks are unfriendly or even disrespectful. Wearing a mask changes the doctor-patient relationship.

I recently spent a week attending on the inpatient geriatric ward at our VA hospital. Most of our patients served in Vietnam. Many of them have lived hard lives and are in the hospital with a combination of severe illnesses and significant social problems. Many have little personal social support. 

I was happy to see that the VA no longer requires staff or patients to wear masks. Patients who are coughing are asked to wear masks, and staff who are sick are told to stay home.

I was unhappy to see that most doctors still wear masks. For the house-officers on my team, this included wearing masks in our private conference room. I worked with one house-officer for an entire week, and I never once saw his face. When I asked him why he wears a mask, he said “I trained during covid, I guess it is kind of a comfort thing.” This physician has accepted a position at a sub-acute nursing facility – a sniff in doctor speak and a nursing home to everyone else -- starting in July. He plans to wear a mask for the rest of his career.

Hiding your face from your attending and colleagues is one thing, but the more important questions is: what impact does wearing a mask have on our ability to provide outstanding patient care? How does it feel for our patients who are sick and alone in the hospital to never see a human face? Most of us went to medical school with a dedication to help sick people feel better. Should showing your face to one’s patients be considered minimum standard of care for physicians on inpatient medical wards? 

Walking into a patient’s room in April 2024 wearing a surgical mask, I feel like we are saying three things:

1.     We think you are a danger to us.

2.     Our comfort is more important than yours.

3.     Even though I am a physician and trained in the scientific method, I am pretty bad at assessing risks.

In the early days of the AIDS epidemic many physicians – shamefully -- refused to touch patients with HIV. We adopted universal precautions in order to protect healthcare workers when the risk was real and reprimanded people who wanted to take more extreme measures.

Covid has not disappeared. As we always have, internists will continue to take care of sick patients with respiratory illnesses. We should continue to take reasonable precautions in risky situations but draw the line at extreme measures.

Always wearing a mask on a medical service in 2024 is an extreme measure and lies outside what should be considered acceptable professional behavior.

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Catherine Sarkisian is a Professor of Medicine at the David Geffen School of Medicine at UCLA who has been taking care of older adults for over 20 years. In this commentary she is speaking for herself, not on behalf of her employer.

Photo Courtesy of JESHOOTS.COM