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The smile behind the mask


Earlier this week I was in an ED but, instead of being in my usual role as a doctor, I was there as a relative. It was scary. I was worried and everything was strange. People walked down the corridors in single file, wearing masks. The public areas were silent. The coffee shop was deserted. I didn’t really know any of the staff but I was so touched by the kindness shown by people I’d only ever known on Twitter. As I spoke to a consultant dressed in full PPE, it really struck me how much harder we have to work to convey tenderness and warmth behind the mask, how difficult it is to show our patients we’re there for them as humans as well as diagnosticians, how terrifying it must be for our younger patients, the children at the heart of COVID.

While chatting with the DFTB team about what we can do to make our own places of work less scary during COVID, Damian reminded me about this video by EM3. Imagine the same video with staff in full PPE. Imagine what it’s like to be in your COVID ED from the perspective of a frightened child.


Our children are struggling with isolation and suffering with worry, anxiety and fear. And while speaking to the ED consultant, feeling those emotions myself, I resolved to go on a hunt for ways we can unmask our smiles.


Ask how things are going

We can make an extra effort to ask how our patients and their parents are feeling. Daniel Summers has written this moving article which is touching in its exploration of empathy.

“To my usual list of questions about diet and exercise and sleep and such, I have started asking parents “so how are you doing with all of this?” How is it with your kid at home with you all day, every day? What are their school’s expectations? How are things with the work you have to do yourself? How are you coping?” Daniel Summers.


Show who are you are beneath the mask

Writing our name on our PPE replaces our hidden lanyards (#hellomynameis has never been more important) but our faces, which usually convey so much emotion, tenderness, and warmth, still remain hidden. I love the idea of a photo to show the person behind the PPE.

Maybe a laminate a few and disinfect them between patients or, instead, use a paper print out or a sticker, and get a new one per patient.


Pimp your PPE

Conversations on Twitter have highlighted some great ways we can pimp our PPE (what a great hashtag that would make). So, although we probably shouldn’t be drawing on our masks as it might impact on their effectiveness, that doesn’t stop us making our visors more beautiful.

If you have the skills then drawing on aprons is another way to pimp your PPE, demonstrated so brilliantly on the Portsmouth PED catwalk.

An alternative is to whip out those accessories to wear under the PPE.


Make kids giggle

We’re used to hunting for dinosaurs in ears and using our magic hands to feel for brekkie in bellies, so why not use some silliness to break the ice.

Be a superhero…

…play a game…

…or just be funny.


We are advocates of smiling eyes and a playful disposition, open and positive body language and tone of voice.” Sian Spencer-Little, explaining the philosophy of the play team at GOSH.


Use communication cards

Inspired by an adult patient who described feeling terrified because he couldn’t understand what his clinicians were saying through their PPE, an anaesthetist in the NHS has developed, a collection of flashcards used to communicate with patients. These could be adapted for older children, with language pitched age appropriately.

And for younger children? While chatting about how we can overcome the PPE barrier with children, Sian told me she’d been thinking about using wipeable PECS cards (from the picture exchange communication system), adding images of masks, visors and other images to explain our PPE.


Add a bit of colouring

These lovely colouring sheets have been created by Stephen Browne, an Irish designer, and Emma Fratangelo, a play specialist in Children’s Health Ireland. Click on the image to download the pdf for your own hospital.


Put up some posters

And if your department is looking for some posters or information to give to children, these resources are lovely for children both young and old.

“We might look a bit different than usual. It’s ok to laugh!”, Katie Chappell.


Thanks to Amanda Stock and the team at RCH for this great video that takes a little of the mystery out of PPE.

And so, while COVID reigns we don’t have to be hidden behind our PPE. We can show our smiles behind our masks.

“What I miss most in this current climate is normal human contact, the essence of our everyday and medical world – the unmasked smile, the warmth of a handshake, the reassurance of a touch on the shoulder, the hug from a patient when a particular connection has been made… But, I also know that the common bonds that bring us together will be strengthened, not weakened by this experience.” Gaye Cunnane, the Royal College of Physicians of Ireland.



Monkey Wellbeing resources can be found at

Katie Chappell’s cartoon is available in English and Welsh at


  • Dani Hall is a PEM consultant in Dublin, member of the DFTB executive team and senior clinical lecturer on the Queen Mary University of London and DFTB PEM MSc. Dani is passionate about advocating for children and young people, and loves good coffee, a good story and her family. She/her.

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1 thought on “The smile behind the mask”

  1. This was delightful. My charity of choice has been making cloth visitor masks that are given out at one of our local hospitals. Now they asked us to make some in the size for kids that are smaller and so we are. The ones I cut are of juvenile fabrics so they might be seen as friendly to the kids and parents can make an ooh and ahh moment for the kids.

    Last time I was at the doctors they asked me to put on a paper mask, which is hard to breathe through, and now they request you bring your own cloth face covering to use while at that location.

    The doctors for regular follow up visits don’t wear a mask, but certainly ask the patients to do so so when you speak you don’t spatter your saliva in the rooms.