A friend of mine who is a doctor posted that they’d had a patient who had come in both denying the existence of COVID-19 and declaring that masks kill you faster.

Unfortunately, I see this kind of post frequently from friends (and friends of friends) in the medical community. Including, all the way to denying that COVID-19 is real even as they die of it.

The general advice for dealing with people who have a wildly different world view is:

• Empathy, both emotional and thought. Try to understand their actual underlying concerns. If they think X, how does that make them feel. This usually involves asking non-judgemental questions.
• Disarm them. Find something, anything to agree with, avoid sarcasm and still be truthful. For example, you might say “You’re right, masks really are uncomfortable” or “I also find it really annoying to have to wear a mask all the time”

I recommend Chapter 6 of Feeling Good by Burns. These skills are hard, particularly when it comes to doing them face to face in real time. I can sit here and come up with how I would suggest responding, but that’s really very different from having to do it on the fly. I think it’s a skill worth learning though, while I’m still not great at the face to face side of things, working on these skills has drastically improved my written communication.

To directly answer your two questions: What does this person think they are achieving by saying this to me?

Unfortunately, only they know. Guesses include:

• They are uncomfortable and are looking to get you to agree to removing masks. This may be something like sweat build up on their face or difficulty in understanding you because they’re used to reading lips/facial expressions and can’t.
• They’re frustrated by the pandemic and just want it to be over. Probably they’re also afraid as they’re hearing all kinds of conflicting information and it’s difficult to know what’s right.
• They’ve not had any direct contact with people with COVID-19 and are looking to validate their world view based on the lack of experience.
• They’re anxious and picking a fight brings with it adrenaline and other hormones which can help mitigate the anxiety.

And how am I supposed to reply?

Take a breath to give yourself time to think and calm down.

Ask questions. Perhaps starting with something along the lines of: I’m curious as to what caused you to bring that up?

Other snippets which I can imagine being useful include:

• I imagine that our mask mandate is really annoying. I too find them annoying, sweat builds up, it’s harder for patients to understand me and I end up with ruts in my face from where the mask presses all day. What do you think I might feel when someone complains to me about masks?
• I’m guessing that no one you know has had COVID-19 so all the worry seems out of touch with your personal experience. Is that right?
• I can understand how it might seem like a thing that’s made up if you’ve not had anyone in your community exposed to it. Unfortunately, we have a lot of patients here who have it. I’m happy to answer any questions you might have. Would you like to see an autopsy photo of a COVID-19 lung? (I’m assuming you can get such a photo, it’s appealing to most people’s sense of macabre to start a conversation. “What would you like to ask first?” could be an alternative)