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Updated: March 2, 2022
How to respond to patients who refuse to wear a mask in a healthcare setting, and responding to requests for notes that exempt patients from mask wearing.
If mask mandates are withdrawn, should I still require patients to wear a mask?
As public health measures are withdrawn, there may be a period of transition during which masks may continue to be recommended but not mandated in public spaces.
In considering any ongoing masking policies, physicians will want to follow direction and consider guidelines from their ministries of health, chief medical officers of health, and medical regulatory authorities (Colleges). These guidelines may speak to whether a masking policy should be maintained, as well as other safety precautions, including whether to continue with screening, distancing, hand hygiene or other practices. Physicians may also wish to consider the approach taken by related services in the community and other relevant circumstances including health care capacity and prevalence of COVID-19 in their community.
In cases where patients are requested to wear a mask despite the withdrawal of applicable mandates, it will be important to alert patients in advance of the rationale for wearing a mask when attending in-person visits. Patients may be more willing to wear a mask if the reasoning is clearly explained to them (i.e. minimizing the risk of exposing healthcare workers and other patients).
For patients who decline to wear a mask, physicians will need to determine how best to provide care. If appropriate and in accordance with College policies and standards, patients may be offered virtual care. Where the patient’s needs require an in-person visit, physicians will want to consider how best to provide care and whether it is necessary to safely isolate the patient.
How do I manage patients who refuse to wear a mask?
There may be various reasons why some patients are reluctant to wear a mask. Some patients may have health conditions that make it challenging or uncomfortable to wear a mask. Other patients may not have the financial means or may have difficulty obtaining masks.
It is important to alert patients in advance of the need and rationale for wearing a mask when attending in-person visits. Patients may be more willing to comply with wearing a mask if the reasoning is clearly explained to them (i.e. minimizing the risk of exposing healthcare workers and other patients). In some provinces/territories, it is mandatory to wear masks in indoor public spaces, including physicians’ private offices, clinics and other healthcare settings. In these jurisdictions, fines may be imposed for not enforcing mask wearing directives. It may be helpful to remind patients in these jurisdictions that mask wearing is mandatory and therefore in-person care may not be permitted unless the patient wears a mask or is exempted from wearing a mask (e.g. children or persons with certain medical conditions).
If feasible, physicians should offer to provide patients with a mask if they are unable to obtain one. For patients who continue to decline to wear a mask, physicians may offer to see them using virtual care, if appropriate. Where the patient’s needs require an in-person visit, physicians should consider whether it is possible to safely isolate the patient and provide care. In some cases, it may be reasonable to redirect patients to another healthcare setting that can more safely provide care.
Physicians will need to exercise their clinical judgment in every case to determine whether a patient should be prevented from receiving in-person care for refusing to wear a mask, even in jurisdictions where mask wearing is mandatory. Physicians will want to make best efforts to find reasonable alternatives to provide care to patients who decline to wear a mask. A refusal to provide care could put a physician at risk of a College complaint, human rights complaint and/or civil action; the success of which will depend upon the specific circumstances, including mandatory mask wearing directives. The CMPA is aware that the Colleges are taking into account the current COVID-19 situation and would assess any complaint in that context.
Am I required to comply with requests from patients to complete notes that exempt them from wearing a mask, being vaccinated, attending school or work and/or engaging in any other activities?
Physicians should exercise clinical judgment on a case-by-case basis in determining whether an exemption note is warranted based on the patient’s medical condition and circumstances. Although physicians have a general obligation to help patients by providing medical reports or certificates when warranted, they are also responsible for giving sound medical advice.
Physicians should generally only complete these documents if the request is clinically indicated and in keeping with published guidelines. Any statements made should be truthful and based on objective clinical information.
It is reasonable to decline completing exemption notes if the request is not clinically indicated or you do not have the sufficient knowledge or expertise to opine on the issue. You should explain to the patient in a compassionate and professional manner why the request cannot be granted. An appropriate notation in the medical record of the discussion with the patient, including the basis for providing or refusing the exemption note, will be invaluable in responding to any later challenge of your decision.
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