A Spoonful of Oral Medicine

Dr Amanda Phoon Nguyen

BDSc (UniMelb), MRACDS (GDP), DClinDent (Oral Med) (UWA), MRACDS (OralMed), Cert ADL, FOMAA, FPFA, FICD

Oral Medicine Specialist

Perth, Western Australia

Welcome to A Spoonful of Oral Medicine, where I dish up bite-sized chunks of oral medicine targeted toward health professionals!

This does not constitute personalised medical advice. Please do not use images without credit.


Please enjoy, and I do hope to hear from you! 

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  • Amanda Phoon Nguyen

My Patient Doesn't Want to Wear a Mask

It is likely mask wearing will be part of life for a while, and there will be more intermittent periods of time in the future when it is a government directive. I wrote down some thoughts and responses to FAQs from colleagues.


Disclaimers:

-I am in WA and not sure if this applies to anywhere else.

-This is my private opinion only and I do not speak for anyone else/ any organization.

-Please seek independent advice.

-I strongly advise all to check all governmental and regulatory guidance for the latest updates.



Q: My patients does not want to wear a mask to their dental appointment.


  1. Ask: Why? The patient should be asked this question in privacy, and with sensitivity.


The patient has a medical or otherwise legal exemption.

Q: Can you ask to see the medical exemption?

  • Yes. If a person is relying on an exception under subparagraph (e) (https://www.wa.gov.au/government/publications/covid-19-coronavirus-public-health-and-social-measures-perth-peel-and-the-south-west-frequently-asked-questions#exemptions-from-mask-requirements) and is requested to do so by a responsible person, the person produces a medical certificate that certifies that the person has such an illness, injury, condition or disability that makes wearing a face covering unsuitable.

  • If the patient has a medical or legal exemption, businesses should not refuse service as it may amount to unlawful discrimination.

  • If a patient declines to provide the medical certificate citing that is a breach of privacy, the patient could be reassured that medical certificates generally do not contain specific medical information. As health practitioners, it is important we have their medical history regardless of the COVID 19 pandemic. They may also be directed to the above WA government website.

  • If the 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, on the basis that it is required for their safe dental treatment and is unconnected to their refusal to wear a face covering.

  • Triaging the patient before the appointment is helpful to avoid these situations at the practice. This may include a phone call prior to the appointment (together with confirming the patient is not unwell and hasn’t been to Covid exposure sites), and information should also be easily accessible on your practice website/social media and on your practice door.

2. The patient does not feel wearing a mask is effective.


This may be an opportunity to educate and empathize. It is important the patient understands why the mask mandate is in place. It may be confusing for patients, as at the start of the pandemic, there were conflicting reports, and the WHO and CDC advised against wearing masks at that time. However, as time progressed, the studies have shown that wearing facemasks and face coverings do reduce the spread and the advice has changed.

It is true that wearing a mask is not foolproof, and that is why physical distancing and proper hand hygeine is also very important.

3. The patient feels that a “mandate is not law”.

It is a government directive that masks are mandatory for Perth and Peel in all indoor public venues from 6pm, 16 January 2022. https://www.wa.gov.au/government/covid-19-coronavirus/covid-19-coronavirus-what-you-can-and-cant-do

4. Patient claims restriction to personal liberty


There are limits to personal liberty, and patients not wearing masks in healthcare facilities can pose a risk to healthcare workers and patients.



  • If the patient refuses to comply without a lawful exemption.


  • Remain calm

  • Provide a face mask if the patient is willing to wear one. A face shield/scarf/bandana is not considered a substitute.

  • Maintain duty of care: if it is an urgent or emergency situation, please seek advice.

  • Duty of care can have limits. When patients’ behavior poses a risk to the practitioner, staff and other patients, or when the patient is abusive, clinicians are justified in restricting the provision of care.

  • Document.


Tips to reframe:

  • Appeal to the patient for help and appeal to their sense of civic duty, also calmly refer to the WA government directives

  • The patient should understand and be respectful of the anxieties of others around them if they are not wearing a mask

  • Mask wearing can be positively thought to be a sign of caring, rather than oppression

  • Offer an alternative if viable, e.g telehealth

  • Practice deescalation techniques


References

https://www.wa.gov.au/government/publications/covid-19-coronavirus-public-health-and-social-measures-perth-peel-and-the-south-west-frequently-asked-questions#exemptions-from-mask-requirements

https://www.nature.com/articles/s41407-021-0647-3


https://www1.racgp.org.au/newsgp/clinical/face-masks-what-gps-and-patients-need-to-know

https://www.healthywa.wa.gov.au/Articles/A_E/Coronavirus/Face-masks


https://jamanetwork.com/journals/jama/fullarticle/2776536


https://www.wa.gov.au/system/files/2021-02/Face%20Covering%20Directions%20-%2031%20January%202021.pdf


https://ww2.health.wa.gov.au/~/media/Files/Corporate/general%20documents/Infectious%20diseases/PDF/Coronavirus/coronavirus-faqs.pdf

https://www.wa.gov.au/government/covid-19-coronavirus/covid-19-coronavirus-what-you-can-and-cant-do


https://www.commerce.wa.gov.au/worksafe/covid-19-coronavirus-frequently-asked-questions#when-there-are-public-health-requirements-for-masks-to-be-worn-in-my-workplace-and-an-employee-has-told-me-that-they-cannot-wear-a-mask-for-medical-reasons-what-should-i-do-to-meet-my-duties-as-the-employer-

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