Rupert Hoppenbrouwers, senior dento-legal adviser at the Dental Defence Union (DDU), explains how to manage patients who refuse to wear a face covering while at a dental practice.
Whilst rare, a few dental patients who decline to wear a mask or other face coverings during the continuing Coronavirus pandemic are responding to requests to do so with complaints and claims for compensation alleging discrimination. It is therefore important to be alert to this remote possibility and to manage these patients carefully, with a view to reducing the risk of such complaints and claims.
Patients may refuse to wear a face covering because they have a medically diagnosed condition which prevents it, because they suffer from anxiety or a self-diagnosed condition, or because they hold strong views about the need for such precautions during the pandemic. Whatever their reason, it is wise to treat them sensitively and not to operate a 'no mask, no treatment policy'. The GDC's Standards for the dental team1 requires you to treat patients fairly, as individuals and without discrimination, and to comply with the law.
When encountering a patient who declines to wear a face covering, there are a few factors to consider which may help to prevent confrontation and protect patients and the dental team alike.
Firstly, it is important to have practice procedures and protocols in place, but it is preferable not to describe them as practice policies and suggest they apply to everybody, irrespective of their individual needs. Ensure that all patient-facing staff know what the practice protocols and procedures are, and how to manage patients who decline to wear a face covering to avoid confrontation.
Moreover, ensure these procedures are explained to patients, in a clear and simple manner, along with the reasons for them. This information should also be easily accessible on your practice website, when patients book appointments through reception, and when patients attend appointments. It may also be worth sending patients a copy of the practice processes for protecting patients, the dental team and other patients at the time they make their appointment via email and/or text message.
Ask that patients who decline to wear a face covering inform the practice in advance so that suitable alternative arranagements can be made for them.
Additionally, ask that patients who decline to wear a face covering inform the practice in advance so that suitable alternative arrangements can be made for them. For example, it may be appropriate to treat such patients remotely, without a face-to-face consultation or to see them at the end of a session, when no other patients will be present, or having them enter the practice through another entrance which avoids them mixing with other patients. Be alert to the risk that other patients may complain if they encounter someone not wearing a mask in public areas.
If a patient does inform the practice that they are unable to wear a face covering then it is important to avoid confrontation and refrain from suggesting that it is practice policy that every patient must wear a face covering. Instead, see if the patient will reconsider (it may be worth having a supply of masks in case the patient changes their mind or has simply forgotten their mask) but if they do not change their mind, explain that you have procedures in place to accommodate them and what those procedures are.
Furthermore, it is important not to quiz patients in public areas about their reason for declining to wear a face covering, to avoid appearing insensitive and allegations of a breach of confidentiality. If a patient states they have a medical condition which has not been previously declared in their medical history, it is perfectly reasonable for the treating clinician to ask the patient for further information, again in private. That further information should be sought simply to ensure you have a complete medical history for the patient's safe dental treatment, and not to make a judgement on whether the patient's refusal to wear a face covering is rational or otherwise.
However, if a patient refuses to give a full medical history, provided the patient understands the reason for asking for it and the consequences of not providing it, it might be reasonable to decline treatment, but only on the basis that it is required for their safe dental treatment and is totally unconnected to their refusal to wear a face covering.
For more information about mask exemption visit www.theddu.com or DDU members can call the DDU's 24-hour helpline on 0800 374 626.
General Dental Council. Focus on Standards. Principle One. Put patients' interests first. Available at: https://standards.gdc-uk.org/pages/principle1/principle1.aspx (accessed May 2021).
About this article
Cite this article
Hoppenbrouwers, R. Managing patients who decline to wear a face covering. BDJ Team 8, 28 (2021). https://doi.org/10.1038/s41407-021-0647-3