Practice Management

Hi Janet,

Let me start with a question: Are you not finding out about the mask objection until the patient is at the office? The patient should be aware of any COVID guidelines ahead of the appointment and any objections should be dealt with before they arrive. If you are dealing with an angry patient on site, this becomes a much harder situation to manage.

In our outpatient center the mask and COVID policies are discussed at the time of scheduling, and again when the patient receives their reminder call. If the patient has any objections to our policies, we let them know about the other local options for imaging. The patient can check with the other providers to see if their locations policies better align with the patient desires. When they find out the other local options have the same requirements, more expensive prices, and longer wait times compared to our outpatient center, they are usually willing to work within our COVID guidelines.

When a patient further pushes that they cannot wear a mask while at their appointment, we ask if this was discussed with their referring provider before sending the order. If there is an actual medical necessity to not wear a mask, their PCP should be aware, and it should have been communicated with the order. If that is the case, we can schedule the patient as the last scan of the day when we have minimal staff and patients in the building. We require the patient to wear a face shield until they are at the modality.  

As for office guidelines, there should also be postings/signage indicating the mask requirement and any other COVID related guidelines.  There should be clear rules established in the office, and they need to be followed by all the patients and staff. Patients that try to break the office rules need to be given a direct reminder by staff that they will not be seen if they do not comply with the rules previously discussed at the time of scheduling, at check-in, and that are publicly posted.

The staff also needs a designated leader to handle aggravated patients. If the staff does not feel supported with a chain of command, they will not feel comfortable enforcing the rules. This leader should try to de-escalate the situation and potentially offer to reschedule the patient for a time when the patient can follow the guidelines.

If a patient becomes belligerent, the designated leader needs to feel empowered to call security/911. You can trespass someone off property for not complying with the established public safety guidelines. While trespassing a patient is not something we want to do, it is a tool to be used if someone is being unreasonable or threatening violence.

As for guidelines, the CDC healthcare facilities operational guidelines offer information on source control and outpatient facility operations. This includes information on face coverings being used in a healthcare setting. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-hcf.html Also, here are a few other links with more helpful information:

https://www.justice.gov/opa/pr/department-justice-warns-inaccurate-flyers-and-postings-regarding-use-face-masks-and

https://www.consumer.ftc.gov/blog/2020/06/covid-mask-exemption-cards-are-not-government

https://www.physicianspractice.com/view/prepare-for-patients-who-refuse-to-wear-a-mask-in-your-practice

Last thought, most anyone who is coming in and threating legal action is most likely trying to use a scare tactic to get their way. I would not be quick to bow down to their requests. We do not want to deny patients care, but if they are in such a shape that they cannot wear a mask for the short duration of an appointment, I am not sure that an outpatient center is the best option for them. They may need to consider going into a hospital setting that is better prepared to handle patients in that condition.

Hi Janet,

Let me start with a question: Are you not finding out about the mask objection until the patient is at the office? The patient should be aware of any COVID guidelines ahead of the appointment and any objections should be dealt with before they arrive. If you are dealing with an angry patient on site, this becomes a much harder situation to manage.

In our outpatient center the mask and COVID policies are discussed at the time of scheduling, and again when the patient receives their reminder call. If the patient has any objections to our policies, we let them know about the other local options for imaging. The patient can check with the other providers to see if their locations policies better align with the patient desires. When they find out the other local options have the same requirements, more expensive prices, and longer wait times compared to our outpatient center, they are usually willing to work within our COVID guidelines.

When a patient further pushes that they cannot wear a mask while at their appointment, we ask if this was discussed with their referring provider before sending the order. If there is an actual medical necessity to not wear a mask, their PCP should be aware, and it should have been communicated with the order. If that is the case, we can schedule the patient as the last scan of the day when we have minimal staff and patients in the building. We require the patient to wear a face shield until they are at the modality.  

As for office guidelines, there should also be postings/signage indicating the mask requirement and any other COVID related guidelines.  There should be clear rules established in the office, and they need to be followed by all the patients and staff. Patients that try to break the office rules need to be given a direct reminder by staff that they will not be seen if they do not comply with the rules previously discussed at the time of scheduling, at check-in, and that are publicly posted.

The staff also needs a designated leader to handle aggravated patients. If the staff does not feel supported with a chain of command, they will not feel comfortable enforcing the rules. This leader should try to de-escalate the situation and potentially offer to reschedule the patient for a time when the patient can follow the guidelines.

If a patient becomes belligerent, the designated leader needs to feel empowered to call security/911. You can trespass someone off property for not complying with the established public safety guidelines. While trespassing a patient is not something we want to do, it is a tool to be used if someone is being unreasonable or threatening violence.

As for guidelines, the CDC healthcare facilities operational guidelines offer information on source control and outpatient facility operations. This includes information on face coverings being used in a healthcare setting. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-hcf.html Also, here are a few other links with more helpful information:

https://www.justice.gov/opa/pr/department-justice-warns-inaccurate-flyers-and-postings-regarding-use-face-masks-and

https://www.consumer.ftc.gov/blog/2020/06/covid-mask-exemption-cards-are-not-government

https://www.physicianspractice.com/view/prepare-for-patients-who-refuse-to-wear-a-mask-in-your-practice

Last thought, most anyone who is coming in and threating legal action is most likely trying to use a scare tactic to get their way. I would not be quick to bow down to their requests. We do not want to deny patients care, but if they are in such a shape that they cannot wear a mask for the short duration of an appointment, I am not sure that an outpatient center is the best option for them. They may need to consider going into a hospital setting that is better prepared to handle patients in that condition.