Open Access Highly Accessed Research article

Effect of facemasks on empathy and relational continuity: a randomised controlled trial in primary care

Carmen Ka Man Wong1, Benjamin Hon Kei Yip1*, Stewart Mercer2, Sian Griffiths1, Kenny Kung1, Martin Chi-sang Wong1, Josette Chor1 and Samuel Yeung-shan Wong1

Author Affiliations

1 JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4/F, School of Public Health building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR

2 General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, 1 Horseletthill Road, Glasgow G12 9LX, UK

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BMC Family Practice 2013, 14:200  doi:10.1186/1471-2296-14-200

Published: 24 December 2013



There is limited evidence to support the use of facemasks in preventing infection for primary care professionals. Negative effects on communication has been suggested when the physician wears a facemask. As communication skills and doctor patient relationship are essential to primary care consultations, the effects of doctor’s facemask wearing were explored.


A randomised controlled study was conducted in primary care to explore the effects of doctors wearing facemasks on patients’ perception of doctors’ empathy, patient enablement and patient satisfaction. Primary care doctors were randomized to mask wearing and non mask wearing clinical consultations in public primary care clinics in Hong Kong. Patients’ views were gathered using the Consultation and Relational Empathy (CARE) Measure, Patient Enablement Instrument (PEI) and an overall satisfaction rating scale. The effects of face mask wearing were investigated using multilevel (hierarchical) modelling.


1,030 patients were randomised to doctor-mask wearing consultations (n = 514) and non mask wearing consultations (n = 516). A significant and negative effect was found in the patients’ perception of the doctors’ empathy (CARE score reduction -0.98, p-value = 0.04). In the more established doctor-patient relationship, the effect of doctors’ mask wearing was more pronounced (CARE score reduction -5.67, p-value = 0.03).


This study demonstrates that when doctors wearing a facemask during consultations, this has a significant negative impact on the patient’s perceived empathy and diminish the positive effects of relational continuity. Consideration should be taken in planning appropriate use of facemasks in infectious disease policy for primary care and other healthcare professionals at a national, local or practice level.

Clinical trial registration

This trial was registered on Chinese Clinical Trial Register (ChiCTR). Registration no.: ChiCTR-TTRCC-12002519. URL: webcite. Due to administrative error, registration of trial did not take place until after the trial started on 1st August 2011 and registration number was released on 21st September 2012.

Public health; Primary health care; General practice; Continuity of patient care; Empathy