Masks in the Medical Practice: Can Patients Refuse?

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Public health officials and regulatory bodies have been clear that those working, visiting or being treated in a healthcare setting should wear face masks to reduce the spread of COVID-19. While face masks and their overall effectiveness have been questioned by some, wearing a cloth face covering has been shown to reduce the rates of COVID transmission in the population and may even reduce the severity of illness for those who are infected. For this reason, it is recommended that all healthcare providers require patients to wear face masks when they are receiving medical care.

Unfortunately, some patients are unable to safely wear a mask in healthcare settings and/or may refuse, citing a disability or health issue, personal beliefs regarding the utility of a mask, or a perceived civil right. Prudent medical practices will prepare a game plan for these eventualities.

MIEC recommends the following:

  • Post mask-wearing expectations on your website and at your practice location. Reiterate mask requirements and other COVID protocols during appointment reminders/COVID symptom screening calls. If patients indicate reluctance to wear a mask, inquire as to the reason.
  • Ascertain whether the patient’s objection is due to a health issue (see examples below) versus the patient’s personal beliefs.
    • If the refusal is related to a health condition: offer reasonable alternate accommodations, such as a telehealth visit, allowing the patient to wear a face shield in lieu of a mask, or assisting the patient with putting on and removing the mask. Work collaboratively with the patient to address their concerns before the patient arrives for their appointment. If you are unable to reach an accord, call MIEC for advice. Even if the patient has a disability, the patient’s individual needs do not necessarily outweigh the public health issue of COVID-19 and the medical practice’s duty to protect other patients and its staff. A situation-specific approach would take these factors into consideration as well as the potential risk of delaying patient care until such time as COVID-19 is no longer deemed a public health emergency.
    • If the refusal is related to personal beliefs: Do not argue with the patient over whether they have a “right” not to wear a mask. Calmly refer to state and local mask ordinances, if applicable. Confirm that the patient is not experiencing an emergency medical situation. Reiterate that they will not be treated without a mask in the office setting. Document the discussion.
  • Train staff in de-escalation techniques to address emotional discussions. Review workplace violence policies and procedures to ensure disruptive patients are handled appropriately in intensifying situations.

Educating patients up-front about mask-wearing expectations, working collaboratively when appropriate on reasonable accommodations, and providing staff with training and a plan should help everyone “breathe a little easier” around the subject of masks.

Examples of health conditions or disabilities that could impede wearing a face mask:

  • Individuals with asthma, COPD or other respiratory disabilities.
  • People with PTSD, severe anxiety, claustrophobia, or autistic sensory sensitivities.
  • People with cerebral palsy or other conditions impeding mobility necessary to don a mask.
  • A person who uses mouth control devices to operate a wheelchair or assistive technology.