The Case of the Unmasked Patient When a patient’s refusal to wear a mask causes a scene, should he be dismissed from the office despite some continuity of care concerns? Dr. Yuen’s large optometry practice had only been open about fifteen minutes when David appeared at the check-in desk. “Sir, did you leave your mask in your car? We need you to go get it,” said Maya, the receptionist. He ignored her question. “I have a follow up appointment with Dr. Yuen at 8:20.” “Sir.” David reached into his jacket pocket for his wallet, pulled something out, and dropped it on the counter between them. The receptionist peered down at the ADA mask exemption card. “Sir, you know that isn’t real, right?” she said. “If you don’t wear a mask I’m going to have to ask you to leave.” David’s face flushed in anger. “I’m not wearing a damn mask. Get the doctor. I want to talk to him.” “Sir he’s already in patient care, and he isn’t going to tell you anything different,” she said, clearly exasperated. “Wait, weren’t you here two days ago? Wearing a mask?” “Yeah, and it was awful! I have asthma, I’m not doing it again,” he said. “Well, we can’t see you without one,” she said again. “There’s no mandate! They lifted it, you just don’t want to help me! My eye still hurts. I HAVE to see him!” David bellowed. There were two older women sitting on opposite sides of the waiting room; both of them looked up from magazines. The exchange went on for several minutes, but when David leaned over the reception desk and started cursing Maya put her foot down: “You can leave, or I’m going to call the police.” “Go ahead!” he shouted, and pulled a cell phone from his back pocket. He shoved it in her face. “I’m getting this whole fiasco on camera, lady.” Maya’s hand shook as she held the phone to her ear and called the local station. David continued to rant and wave the cell phone around. ABOUT THE AUTHOR NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at [email protected] EDITOR’S NOTE: Real Deal is a fictional scenario designed to read like real-life business events. The businesses and people mentioned in this story should not be confused with actual businesses and people. After a few moments Dr. Yuen emerged from an exam room to escort a patient to check out. He smiled reassuringly at the very uneasy ladies in the waiting room. “David, please come with me,” said Dr. Yuen, gesturing towards the back hallway. “I have masks back here, I’ll give you one. We’ll be quick.” “FORGET IT,” David barked. “Okay….” Dr. Yuen paused. “What are you looking to have happen here, David?” Just then two police officers came through the front door. Statements were given, David was escorted to his car, and the staff did their best to carry on with the day. Late that afternoon Maya met with Dr. Yuen in his office. “Are you okay?” he asked. “I mean… he threatened me? So not great,” she said sarcastically. “Didn’t you hear him? I’m not a manager, I needed help and no one had my back.” Not wanting to admit he had been stalling with his patient, he vaguely shook his head no. Maya, tired, didn’t push it. “I started to type up his dismissal letter but we have some issues with continuity of care,” she said. Dr. Yuen nodded. “I’m managing his glaucoma. But the pandemic isn’t going away in the next 30 days, and David is likely litigious. So now what?” QUESTIONS TO CONSIDER 1. Dr. Yuen wants to dismiss David from his practice, but manages his glaucoma. Should he abide by the 30-day notification rule and allow no mask for the visits? 2. Did Maya handle this correctly? How would you handle a patient who refuses to wear a mask? 3. If David posts his video online, what should be the office’s public response? Fill out my online form.