DO’s and DON’Ts for Discussing Face Masks and COVID-19 Vaccinations with Patients – Michigan State Medical Society

Should I be wearing a face mask?

Should I get a COVID-19 vaccine booster?

These are just two of the many questions and concerns physicians and other health care providers frequently encounter when discussing face masks and COVID-19 vaccines with patients. The following guidance is intended to provide some suggested practices for physicians when engaging patients in these discussions.

DO encourage patients in areas with high COVID-19 Community Levels to mask up.

According to current Centers for Disease Control and Prevention (CDC) guidelines, all individuals 2 years and older, regardless of vaccination status, living in areas with high COVID-19 Community Levels should be masking in public. The CDC also recommends in areas with medium COVID-19 Community Levels, individuals at high risk for severe illness and immunocompromised should speak with their physician about taking additional precautions in public, such as mask wearing.

The CDCs COVID-19 Community Level recommendations do not apply in health care settings. Health care setting should continue to monitor community transmission rates and follow CDCs infection prevention and control recommendations for health care settings. Currently, most areas across the country and nearly all of Michigan are presently considered to have substantial or high transmission of COVID-19.

DO encourage patients to get vaccinated.

Based on CDC and FDA guidelines, patients should be encouraged to receive the COVID-19 vaccine to help build protection from the virus. Physicians should counsel patients, who are not candidates for the vaccination due to medical conditions, on risk mitigation strategies, such as wearing face masks indoors, social distancing and hand washing.

DO encourage eligible patients to receive COVID-19 boosters.

When recommending booster doses for patients, reassure patients that the vaccines are effective, but research has shown a slight decrease in protection over time. Remind patients that booster shots are normal for vaccines, such as the annual flu shot or Tdap booster every 10 years. COVID-19 boosters offer elevated protections and have worked well against most variants. Pursuant to the latest CDC guidance from February 2, 2022, the following individuals are currently eligible for a booster dose of the COVID-19 vaccine:

For further recommendations regarding to COVID-19 vaccine eligibility, special clinical considerations, and alerts, visit the

Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States webpage.

DO use effective communication that is tailored to the patient.

Physicians are a trusted source of information for patients and you should share accurate, clear, and easy-to-find information that addresses common questions. In encouraging patients to getvaccinated against COVID-19 it is important to listen to patients concerns. Professional answers to patient questions and concerns matter and can help them make an informed decision about receiving the vaccine.

Physicians should consider using words which will better resonate with each patient. For example, when discussing the benefits of COVID-19 vaccination, explain the safety of the vaccine and the benefits to the patient and his or her family. Physicians should also be transparent with patients, such as discussing potential side effects of the COVID-19 vaccine or the effectiveness of cloth vs other types of face masks in preventing the transmission of COVID-19 indoors or in crowded places.

Physicians should avoid using judgmental language against individuals with face mask or vaccine concerns, which could negatively impact the patients trust and the overall physician-patient relationship. In addition, sharing facts about face masks and the COVID-19 vaccine, as opposed to personal opinions, may be more effective.

DO continue to implement COVID-19 policies and other infection prevention measures recommended by the CDC and MDHHS.

The CDC continues to recommend that medical practices and facilities use additional infection prevention and control practices during the COVID-19 pandemic, including, but not limited to, telehealth visits where medically appropriate, screening patients and visitors entering the facility for signs and symptoms of COVID-19, and implementing source control measures, such as face masks.

If a patient or visitor objects to or refuses to comply with the practices COVID-19 policies, such as refusing to wear a face mask, physicians should ensure its policies include a protocol for explaining the CDCs guidelines for health professionals, which may be different from mandates or guidelines for individuals, and that a patient must comply with the policies while inside the facility. If necessary and appropriate, the patients appointment may be rescheduled to a telehealth visit, or the patient may be referred to another physician for treatment.

DONT routinely terminate patients who refuse to receive the COVID-19 vaccine.

It has been reported in the media that some physicians are refusing to treat unvaccinated patients. In other instances, some physicians have declined to treat children based on the parents vaccination status, although the American Pediatric Association advises against refusing to treat pediatric patients based on parental vaccination status or position. Generally, a physician is legally free to determine whom to treat and to end the physician/patient relationship with appropriate advance notice. Until consensus develops on any potential ethical, licensing or liability risk exposures that physicians could face by routinely declining to treat individuals who are unvaccinated or due to the vaccination status of others, physicians should consider making treatment decisions based on the facts and circumstances of each situation.

DO implement a process for handling patient claims of medical exemptions from the practices COVID-19 policies applicable to patients.

Medical practices are generally considered places of public accommodation and must comply with the federal Americans with Disabilities Act as well as Michigans Persons with Disabilities Civil Rights Act, when enforcing the practices own COVID-19 policies. Physicians need to have a process to address requests by patients and visitors for exemptions from the practices face mask mandate or similar policies based on medical grounds and to assess whether or not reasonable accommodations are possible. Physicians should not assume that an unmasked patient or visitor cannot medically tolerate a face mask or comply with other COVID-19 policies, but physicians are permitted to accept the patient or visitors verbal representation to that effect. Best practices advise to not request medical documentation from the patient or visitor to determine whether the patient or visitor has a disability warranting a reasonable accommodation.

DONT provide face mask or vaccine exemption letters or documentation to patients which are not medically necessary.

Several media sources have reported on several physicians who have been disciplined by various state medical boards for issuing medical exemptions to patients without an objective medical basis for the exemption. Some physicians individually oppose policies which mandate face masks or COVID-19 vaccinations. Other physicians may empathize with patients who may be negatively impacted by their refusal to comply with mandatory COVID-19 policies, such as a patient who may face termination from employment unless the patient receives the COVID-19 vaccine. Regardless, physicians should not attempt to help patients circumvent COVID-19 policies applicable to patients by drafting letters or other documentation regarding the patients medical condition that is false or misleading.

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DO's and DON'Ts for Discussing Face Masks and COVID-19 Vaccinations with Patients - Michigan State Medical Society