COVID-19: A Policy Conflict Between a Physician and Management That Sends the Wrong Message to Patients

Earlier today, a physician working for a large health system posted a public “rant” on social media about the ineffectiveness of masks on filtering virions. The post, at least in the region, has effectively gone viral (see what I did there?). You may find the rant published here. The physician makes a strong case for his position, although he does not cite any sources to support his position. It is, after all, a rant. I will give him a pass. But the accuracy of his points is not my focus. What I do find interesting is the social commentary that followed pointing out that the policy at the physician’s medical practice includes the mandate that employees of the practice and throughout the health system wear masks.

The physician’s readers have exposed what looks like a conflicting policy to the general public…mixed messages, hypocrisy even.

I am not going to debate the clinical points this physician makes because, without citations, the points stand as his educated, but biased, opinion. I will dig into the bias in a moment. What bias, you ask? Example: “The pore size of the N95 mask, the best mask we have available commercially, is 0.3 microns…” Pore size is not uniform and ranges in an N95 mask from 0.xn--3m-99b to 0.1 μm – small variation to the naked eye, but large enough when talking virions. This stat is pretty simple to research and reference (as my mother would say – look it up), and I’m sure he looked it up as most of us in the business don’t commit statistics like N95 pore size to memory. He chose the larger end of the range to drive home his point.

I will say that I generally agree with his points proportional to the generalization of the context within which he makes them. In other words, he offered his educated opinion without getting into the science and without citing sources, so I’ll agree that it reads well and makes sense. However, the distance between his position and an equally compelling and antagonistic position is a simple Google search away. But as I stated, that isn’t the point. So, what is the point?

Why would his medical practice employ a protocol that seems to conflict directly with the physician’s position on mask effectiveness?

The easy answer is that this is the health system’s policy – his employer – and not his own. The more profound question is why would a health system implement this policy when conflicting information exists, and members of its medical staff publish public statements such as this? I believe that there are two reasons.

First: Legal liability. I have many attorney friends, most of whom work in health law, personal injury, business law, etc. They tell me that litigation is going to be skyrocketing on the other side of the pandemic. Already people are wearing out the phone lines with them wanting to take legal action against their employers for not providing proper protective equipment, forcing them to work, etc. I spent much of last Friday drafting a “Return-to-Work” policy for my company, with the sole purpose of avoiding legal liability.

Second: Healthcare consumerism. Patients have choices, and they are more independent and mobile with their healthcare choices than at any other time in our history. People make up their minds, irrespective of how uninformed or misinformed they may be, and make choices. Even if masks don’t work, businesses will require their employees and customers to wear them because…wait for it…that is what everyone else is doing. If your business is a non-conformer, your customers may go elsewhere. This likelihood is especially true in a medical practice where Covid-19 patients are treated.

Decisions are not being made by simply relying on science. There are other influences at work on decision-makers at every level, from federal and state governments to large and small businesses, and even you and your family.

Now back to the bias. Everyone you read or listen to is attempting to influence you. Be very careful listening to the media, politicians, and even physicians, particularly physicians appearing on TV at the behest of a politician. Do you blindly trust your physician? Do you agree with everything they tell you to do without question? You shouldn’t.

Everyone is influenced. Everyone is pressured. Everyone is trying to influence and pressure you to agree with or believe in them. All of them do it, including you and me (I’m doing it now), for reasons. Take in the information, but be skeptical. Educate yourself and ask questions. Never conclude with minimal information, especially if that information came from the media with no source. Decide for yourself, but keep an open mind to new information that is emerging every day.