Friday, July 1, 2022
HomeCOVID-19Time to drop the masks in healthcare

Time to drop the masks in healthcare

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THE UK has witnessed the lifting of almost all mask mandates, allowing people to choose whether or not to cover their faces in community settings. Largely as a result of this welcome removal of coercive legislation, there has been a marked reduction in the prevalence of masks in retail outlets, hospitality venues and on public transport. The prominent exceptions are NHS facilities and venues allied to health, with widespread masking of both staff and patrons persisting in all hospitals, health centres and GP practices, and most dentists, opticians and pharmacies. When asked to justify their ongoing ‘requirement’ for face coverings, a common response is that they are following NHS protocols to keep people safe.

Given the sparsity of robust scientific evidence to support the effectiveness of face coverings in reducing viral transmission, together with the wide range of harms associated with them, there can be no justification for healthcare services to continue with the ‘requirement’ for all staff, patients and visitors to wear one. Indeed, several of the negative consequences of mass masking are even more problematic in healthcare settings. Hidden faces impair communication between the professional and patient, re-traumatise victims of historical sexual and/or physical abuse and aggravate the anxieties of people already suffering with obsessive fears of contamination.

Elderly people, the most frequent users of health care, are disproportionately affected with masks aggravating vulnerabilities regarding falls, hearing difficulties and confusion. The Health Secretary, Sajid Javid, recently acknowledged that Covid-19 restrictions had reduced opportunities for the early diagnosis of dementia; even if such patients manage to obtain a face-to-face appointment, masks will present a further impediment to identification of the underlying problem.  

The NHS has long championed its commitment to holistic, ‘person centred’ care, an approach which recognises that effective clinical intervention is not primarily dependent upon the robotic dissemination of medical instructions. The healing process relies heavily on other factors: patients feeling listened to, understood, that their values and preferences are taken into account; a sense of collaboration between the healthcare professional and recipient, and a feeling of retaining some control over the treatment plan. These important non-specific factors, essential for a successful consultation with a doctor or nurse, are highly dependent upon efficient and nuanced communication, involving both verbal and non-verbal channels. When the protagonists are masked, these key elements of a productive consultation are much more difficult to achieve.

The truth is that, irrespective of the professional’s level of technical expertise, without a therapeutic relationship between the caregiver and receiver the effectiveness of healthcare will be compromised. Human connection is the bedrock of the healing process. A therapeutic relationship requires rapport, warmth, compassion, mutual trust and a demonstration of empathy – all much tougher to realise when faces are concealed. It is, therefore, highly concerning that masks are evolving into part of the uniform for healthcare staff.

The combination of little evidence of effectiveness as a viral barrier, and the multiple harms associated with them, suggests that the persistence of masks in healthcare is a triumph of culture over rationality. It is imperative that the guidance for doctors, nurses and other health professionals be revised with immediate effect, leaving the individual (professional or service user) to decide, and thereby bringing healthcare into line with other community settings.

In keeping with this aim, the campaign group ‘Smile Free’ has written an open letter to the NHS chief executives of England, Scotland, Wales and Northern Ireland calling for the removal of the mask requirement from hospitals, GP practices and other health-related facilities. The letter has already been signed by 1,200 health professionals and scientists and more than 3,000 members of the public. Clearly, there is a widespread desire for our health services to return to a more compassionate, person-centred form of care delivery where human faces are on show.

Anyone wishing to add their names to the open letter can do so here.

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Dr Gary Sidley
Dr Gary Sidley
Dr Gary Sidley is a retired NHS consultant clinical psychologist, a member of HART and part of the Smile Free campaign against forced masking in the UK.

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