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Would You Dismiss This Patient for Not Wearing a Mask?

There are continuity-of-care issues for this office to consider…

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DR. YUEN’S LARGE optometry practice had only been open about 15 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.

ABOUT REAL DEAL

Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

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]

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.”

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“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.

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.

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“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?”

The Big Questions

  • 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?
  • Did Maya handle this correctly? How would you handle a patient who refuses to wear a mask?
  • If David posts his video online, what should be the office’s public response?
Kenneth W.
Memphis, TN

First of all, the office has the responsibility to keep patients and staff safe. I would have asked the patient to leave regardless of the condition I was treating.
In my office, the front door remains locked with a sign that says “MASK REQUIRED FOR ENTRY,” thus avoiding any confrontation at the desk. Second point, why are there magazines in the office waiting room during a pandemic?

David G.
Newport Beach, CA

While Dr. Yuen is responsible for continuation of care, the patient also needs to be fully on board to allow this to happen. For instance, if I had to examine a patient’s cup to disc ratio and he wouldn’t open his eyes during the exam, then who is at fault here? The same thing applies with masks: If the patient is deliberately putting a barrier between the examination and management of the disease (or its diagnosis) then it is only them at fault. The patient also needs to realize that being tested without a mask will interrupt the managed care of other patients. Mrs. Jones, for example, might not want to be seen (despite her extensive diabetic retinopathy) because she cares more about her immediate overall health. The doctor then becomes liable in this case, as they did not allow the patient to feel safe to be examined.

Robin N.
Exton, PA

We had the same type of patient. We rescheduled her for the last appointment of the day when no one would be here and examined the patient, so that everyone could be accommodated. Sometimes you have to adjust the rules to help everyone.

Bill H.
Yakima, WA

Does the office have signs up stating a mask is required? If so, there should be no exceptions. Protection of the staff and the other patients in the office is utmost. When a patient refuses to comply and yells or threatens a staff member, do you really want that person as a patient? Offer to transfer the patient’s records to any other office of his choosing. If the patient posts his video, it’s no different from any of the other videos posted. We’ve all already seen variations of this same scenario. The majority of the viewers generally do not look favorably at the person raising a scene and almost always sympathize with the employee just trying to do their job.

Texas S.
Citrus Heights, Ca

Have the patient find an eye doctor that doesn’t require a mask in the office setting, then tell the patient you will be sending records to that doctor. No mask, no service, no exceptions.

Dennis I.
Monroe, CT

This could have been easily handled by explaining that for other people who may be immune compromised, he should be wearing the mask until he gets into the exam room. Once in the exam room he may take it off, if the doctor is comfortable. Otherwise simply ask him to reschedule to the end of the day or very beginning when no one else is in the office. If he can’t wear the mask, then he and the practice must be considerate of other people’s situation and the practice, as well, must be considerate of him.

AJ S.
Houston, TX

Her response was okay, but suggesting a facial shield for his comfort or giving a choice of a 3-ply or KN95 mask would have been better. I have extras for situations like this and KN95 masks are available for less than a dollar.

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Natalie Taylor is an experienced optometry practice manager for Advanced Care Vision Network and a consultant with Taylor Vision. Learn more at tayloreye.com.

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