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Communicating behind a mask: simple strategies to build connection

When disagreement arises between healthcare professionals and patients and their families, the situation can be stressful for all involved. The emotional impact on staff and families means that the possibility for misunderstanding and misinterpretation of views and intentions is high. What is needed is open, empathic communication driven by curiosity to really understand the views of the other person.

But how do we communicate empathy and compassion when the current Covid situation requires us to wear masks, avoid touching each other and socially distance? Our facial expressions and gestures are crucial in conveying our message and in emotionally relating to each other. Our brains are wired to recognise the emotional state of a person by the action of their facial muscles – and crucially the lower and middle part of the face play a major role. These are the very parts that are covered with a correctly fitted face mask.

The non-verbal facial communication of a healthcare professional contributes significantly to the mindset of a patient, with evidence that a clinician’s facial expressions that convey happiness are associated with lower health related anxiety in patients (i) With less focus on the rest of the face, eye contact can be increased. While eye contact is important in conveying empathy, prolonged eye contact can be uncomfortable for some people, particularly if there is conflict or mistrust (ii)

So, when the emotional stakes are high and conveying empathy and openness are key to managing the situation, what practical steps can we take to maximise the chances of us really listening and our message being correctly received?

1. Think about your upper face.

Accentuating the movements of your cheeks, eyes, eyebrows and forehead to compensate for lack of lower facial expression can help to convey the emotion of your message. When listening to others, pay attention to the parts of the face that you can see, and bear in mind that you may not being getting the whole picture.

2. Avoid making assumptions.

Checking in to make sure that we have understood another person, and that they have understood us, is a key aspect of effective communication. With mask-wearing increasing the possibility of misunderstanding, offering the benefit of the doubt and double checking that we have really got the message can avoid upset and confusion.

3. Acknowledge that the situation is difficult.

Being honest about the difficulty of a situation can often ease the anxiety of those involved and brings all parties on the same side in managing the difficulty, rather than fighting each other.

4. Set yourself up for success.

Knowing that masks can cause additional difficulty in communication, carefully consider the setting in which you may have challenging conversations. Think about quieter locations, setting the room up so that people can see each other easily and speaking more slowly with greater articulation and make yourself understood.

5. Consider online interactions

Although meeting in person can be helpful in handling conflict situations, using online technology can mean that masks can be dispensed with and has the added advantage that people cannot speak over each other. The pace of conversation also tends to be slower, which can reduce the reactivity of those taking part.


1. Versluijs Y, Moore MG, Ring D, Jayakumar P. Clinician Facial Expression of Emotion Corresponds with Patient Mindset. Clin Orthop Relat Res. 2021 Sep 1;479(9):1914-1923. doi: 10.1097/CORR.0000000000001727. PMID: 33835095; PMCID: PMC8373558

2. Julia K. Langer, Michelle H. Lim, Katya C. Fernandez, Thomas L. Rodebaugh. Social Anxiety Disorder is Associated with Reduced Eye Contact During Conversation Primed for Conflict. Cogn Ther Res (2017) 41:220–229 DOI 10.1007/s10608-016-9813-x