5 things specialists can learn from each other to boost mask-wearing

When it comes to COVID-19, physicians of all specialties are struggling to better understand, diagnose, treat, and limit the spread of the deadly disease. One thing that’s become crystal clear is that it’s vitally important for patients to #MaskUp to protect others from SARS-CoV-2, the virus that causes COVID-19.

Getting that message across to patients and families can be difficult. In addition to the communications challenge of explaining the evolving science on the efficacy of mask-wearing, there is resistance among some patients who have encountered disinformation among Facebook friends and in Twitter trends.

It is critical that physicians help patients understand their risks for transmission through clear and simple communication that is firmly rooted in science. The AMA is partnering with other leading health organizations to encourage people to mask up to stop the spread of COVID-19.

Five AMA members took time to discuss insights from their specialties that physicians of all stripes can apply to help spread the message to mask up. They are:

• Ricardo Correa, MD, endocrinology fellowship program director and the director for diversity at the University of Arizona College of Medicine in Phoenix.
• Meena Davuluri, MD, MPH, a urologist and health outcomes fellow at New York-Presbyterian/Weill Cornell Medical Center in New York City.
• Pratistha Koirala, MD, PhD, an ob-gyn resident at Danbury Hospital in Connecticut.
• Nicole Riddle, MD, a pathologist and associate professor and associate pathology residency program director at University of South Florida Health.
• Megan Srinivas, MD, MPH, an infectious diseases specialist and translational health policy research fellow at the University of North Carolina at Chapel Hill.

Physicians who perform surgical procedures that require COVID-19 testing are presented with the perfect opportunity to discuss the importance of mask-wearing with their patients, said Dr. Davuluri.

“That leads to a natural segue to talking about COVID-19, and saying, ‘You know, there is an importance of wearing a mask,’” she said, accompanying it with messages about isolating at home and practicing hand hygiene.

“Most patients completely understand, because they want to keep themselves safe” ahead of surgery, Dr. Davuluri said.

Learn about the six things doctors wish patients knew about masks.

Guiding patients through pregnancy and birth as an ob-gyn, Dr. Koirala is accustomed to having delicate conversations with patients.

“I have to talk to my patients about their sex lives and who their sexual partners are, or if they've had an STI in the past,” she noted. Comparatively speaking, talking about the surprisingly divisive question of mask-wearing is “benign.” Even so, applying the essentials of demeanor and rapport-building are critical to making the mask talk a success.

“When you walk into a room, sit down and face the patient, even if there’s a computer in the room and you have to be typing,” Dr. Koirala said. “Just explaining to a patient why you're asking a question can really make a big difference.”

For example, a patient resisted being tested for SARS-CoV-2 because she feared a positive result would mean her child’s being taken away by authorities. Dr. Koirala was able to set the woman’s mind at ease, but first she had to ask what lay behind the woman’s initial decision to refuse the test.

Learn from AMA President Susan R. Bailey, MD, about why it’s time to #MaskUp.

As a pathologist—“the physician’s physician”—Dr. Riddle is accustomed to explaining complicated case reports to sometimes befuddled ordering physicians.

“You’ve got to remain calm,” Dr. Riddle advised. “If anyone has a very particular reason why they don't want to hear what you're saying ... of course that can become frustrating. But you certainly don't want to say something that will immediately shut them down and have them not listen to you at all.”

One skill she’s learned from talking with her fellow physicians: how to educate “without letting them know that you’re educating them.” The same technique can be applied by physicians counseling patients at the bedside or in the exam room.

“Even if you're repeating yourself with slightly different words for the fifth time, try your best to maintain that composure and not get that condescension in your voice,” Dr. Riddle said.

Learn how physicians can help parents when kids struggle with wearing masks.

While wearing cloth face coverings principally protects others, broaching the patient’s own risk profile also can be helpful, said Dr. Correa. As an endocrinologist, he treats many patients with type 2 diabetes or at risk of the disease due to obesity.

Obesity often runs in families and even in social circles, so mask-wearing—along with physical distancing and hand hygiene—is key to protecting those who are most vulnerable.

“In the beginning with COVID, we thought that it was just the older population was the one that was more affected, because this is what we were seeing in Italy,” Dr. Correa said. “When it came to the U.S., we were seeing a different epidemiology and one of the main reasons was because in the U.S., the prevalence of obesity and diabetes was much higher compared with Italy.” 

“We need to make patients aware that it's not only diabetes, but if you are overweight and obese, that's something that you need to be careful about,” he said.

Here’s how physicians can help patients navigate their concerns about COVID-19 risk.

As an infectious diseases specialist, Dr. Srinivas has struggled to ensure her colleagues, patients and the public understand how the experts’ understanding of this devilish coronavirus is changing with new data and evidence. For primary care physicians and others counseling patients on mask-wearing, it’s important to acknowledge and explain how this knowledge base is evolving.

“That's an important point. Anytime people are giving any COVID advice—especially with how the course has changed, and we've seen how public's trust is changing, unfortunately, because of that—just to reiterate and get across the message that this is the information we know now,” Dr. Srinivas said. “These are the strategies I'm giving you now. And it might change in the future as we find out more.”

Centers for Disease Control and Prevention Director Robert R. Redfield, MD, explained the protective value of face masks during an episode of “Conversations With Dr. Bauchner.” Read the JAMA editorial that Dr. Redfield co-wrote, “Universal Masking to Prevent SARS-CoV-2 Transmission—The Time Is Now.”