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John Rademaker, MD, an anesthesiologist in Louisville, Kentucky, became furious when he saw a group of teenage girls congregating in an outdoor area, defying experts' recommendations on social distancing during the COVID-19 pandemic.

Then Rademaker attacked the teens. Police arrested him, charging him with harassment and strangulation. He was also put on administrative leave from his group practice.

The confrontation was captured in a short video that went viral on social media. A woman accompanying Rademaker is shown filming the teenagers with her smartphone, and one of the girls apparently takes the phone away from her. "Give me my phone," the woman says.

Rademaker is shown cursing one of the teens. He moves toward the group, shoves two of them aside, kneels down over the teen who apparently took the woman's phone, and appears to be putting his hands around her neck. The other teens quickly pull the doctor off the girl.

Louisville police identified Rademaker as the man in the video, charged him, and issued this statement: "Obviously, we do not advise individuals concerned about social distancing to take matters into their own hands and confront people about it, especially in any physical way."

Widespread Frustration Toward Patients Who Flout Guidelines 

Physicians throughout the nation, who see firsthand the ravages of COVID-19, are equally frustrated by those who ignore the virus' dangers. Most take out their emotions in different ways.

In the early weeks of the pandemic, Vanessa Walker, DO, a pulmonologist in Roseville, California, was shocked to find that many people in her community did not follow anti-COVID restrictions. After treating COVID-19 patients in the hospital, she would go straight home and avoid public spaces.

"I'm in a bubble in the hospital, with everyone wearing masks," she said, "so I was expecting to find everyone on the outside doing that, too."

Then in May, she went on her first errand since the start of the pandemic, stopping at a local Target store. "About half the people weren't wearing masks," she recalled. Walker overheard a girl in the store asking her mother why Walker had a mask on. Her mother replied, "She's just too worried or too scared, don't worry about her, sweetie," Walker recalls.

"The experience was a complete shock to the core for me," Walker said. "I felt betrayed by the people not wearing masks."Right afterward, while still in her car in the parking lot, she made an impassioned video recalling what she had just experienced, and the video went viral on YouTube.

Walker says she feels safer in the hospital treating COVID-19 patients than in public places. "When I'm in the hospital, I know who has COVID and who doesn't," she said. "Everyone is wearing masks, and I have all the right gear, and I know how to protect myself. But that's not true Walker says that when in public, she would never confront people who are not wearing masks or engaging in social distancing. "It's not good idea to call them out," she said. "Not only is it not a good way to change behavior, but you'd put yourself in harm's way." Standing in close proximity and shouting hastens the spread of the virus, she says.

In certain circumstances, however, she thinks she might be forced to say something. "If someone not wearing a mask came into my personal space, I would either leave, and I would say something to them, but not in a mean way," she says. "It would be about trying to extract myself from the situation."

Watching people ignore recommendations to stop the spread of COVID-19 is especially frustrating for medical professionals, because these people are scorning the efforts of doctors and other healthcare professionals to stop the virus.

David B. Wheeler, MD, a neurologist in Casper, Wyoming, and president of the state medical society, felt his anger mounting while driving past a group of people demonstrating against anti-COVID measures in April.

"They were all standing close together and not maintaining reasonable distancing," he recalls. "Watching them kind of made me sick to my stomach, because they were canceling out the work doctors and other caregivers are doing. We're trying to do everything we can to stop COVID."

Wheeler did not confront the demonstrators. "I always stay as far away as possible from people who don't maintain social distancing or don't wear masks," he said. "If you call them out, you might get attacked, and it's just a good idea from a health perspective to keep clear of them."

Wheeler has publicly advocated for stricter measures against COVID-19 in the state, which resulted in some irate and abrasive comments against him online. "I momentarily thought about responding to them, but then I decided to view them sort of as trolls rather than as serious intellectual debaters," he said.

In a Gallup poll taken in late June, 86% of US adults said they have worn a mask in public in the past week, a record high. But fully a quarter said they sometimes, rarely, or never wear a mask, up from 7% in early April.

Many seem even less concerned about social distancing. In the same Gallup poll, 54% said they are worried about a lack of social distancing, the first time that a majority chose that response. However, one quarter said they were "not too worried," and 21% were "not worried at all."

People not taking anti-COVID measures often develop rationales to justify their behavior, such as regarding the measures ― or the virus itself ― as a hoax, or believing that wearing masks limits breathing to such an extent as to be dangerous.

What About Patients Who Resist Measures in Doctors' Offices? 

Although doctors can avoid confronting people who do not practice anti-COVID measures in public, they're forced to deal with these people as patients in their practices.

"We've had patients who don't want to wear a mask in the practice," said George W. Monks, MD, a dermatologist in Tulsa and president of the Oklahoma Medical Association. "Usually the staff gets the brunt of patients' negative feelings, but sometimes they bring it up to me. They have actually said to me, 'Did you buy into this hoax?' "

Initially, Monks' practice recommended that patients wear masks, but it did not require patients to do so. "We had a patient who verbally confronted a nurse," Monks said. "He was exhibiting hostile physical behavior, and it caused us some concern, but we went ahead and treated him even though he wasn't wearing a mask."

Now the practice requires masks, and problems with patients refusing to wear them have disappeared, he says. "Our office tells patients when they make an appointment that they need to have a mask on to be seen, and if they forget their mask, we can provide one," Monks said. "Patients who are upset about the policy just don't come in.Vanderbilt Health, an academic medical center in Nashville, Tennessee, suggests on its website what staff might say if a patient refuses to wear a mask. One reply takes a direct approach: "I see that you're not wearing your mask. Can you please put one on?" Another reply explains the problem: "Because we are a hospital and there are a lot of sick people here, we ask you to wear a mask to protect our patients, families and staff."

Wheeler says patients who complain about his office's mask requirement focus on the discomfort of wearing one. "Some say they can't breathe easily or that the mask is tickling their face, but we explain why it's important," he said. "We also take patients' temperature and send away patients who have a fever, and they got angry over that."

A study released in May found that men may be more resistant than women to wearing a face covering. They are also more likely view the face covering as shameful, "not cool," a sign of weakness, and a stigma.

The Issue of "Limits on Personal Freedom" 

Many patients complain that masks and other anti-COVID requirements impinge on their personal freedoms, says Aaron Milstone, MD, a pulmonary and critical care physician at Williamson Medical Center in Franklin, outside of Nashville.

"The hospital has a mask requirement and gives visitors a mask if they didn't bring one," he said. "So when I'm seeing patients, I ask patients wearing hospital-issued masks why they didn't bring a mask. It's my opportunity to have a conversation about why masks are important.

"The argument I hear time and time and time again is that this isn't constitutional, you can't tell me what to do," he said. "My answer is, Well, what about speed limits or smoking bans in restaurants and bars? You have to follow those restrictions. People have come to accept those measures, even though initially they complained bitterly about them, too."

Not wearing a mask has become a political statement for many people. In the recent Gallup poll, 98% of Democrats said they had worn a mask in public in the past week, compared with 66% of Republicans who responded. And although 77% of Democrats were worried about a lack of social distancing, only 24% of Republicans felt that way.

For some people, it's a rush to disobey anti-COVID recommendations. "It is possible the act of going out into the world, throwing a party, or running around an otherwise empty city makes people feel strong and alive," a clinical and forensic neuropsychologist commented recently. "It's a thrill to defy authority and defy the consequences."

Mixed Messages Caused Public's Confusion 

Mixed messages from government and medical experts may also have played a role in people's defiance of mask and social distancing guidelines.

In some states, such as Arizona, governors have left it up to counties to decide whether or not to mandate masks, in what situations they are mandated, and whether there should be a penalty for not wearing them.

"Arizona still doesn't have a statewide mandate to wear face masks," said Farshad Marvasti, MD, a family physician who is director of public health, prevention, and health promotion and associate professor at the University of Arizona College of Medicine – Phoenix. "With the continued lack of adequate testing and the high rate of reproduction of the virus, we should be shutting down public activities, and yet they can remain open."

In California, Governor Gavin Newsom initially allowed each county to set its own anti-COVID policies. Walker says the Target store she visited was in a county that did not require the wearing of masks, but there was a mask requirement in another county a mile or so away. Since then, however, Newsom issued a statewide mask requirementNot only government but also medical science has been inconsistent with messaging, says Jill Weatherhead, MD, an assistant professor for infectious diseases at Baylor University in Houston.

"In general, people want to do the right thing to control this virus to protect themselves and the community," she said. "But they have had to deal with mixed messages from science. The scientific process takes time. You need to have robust studies and reproducibility, and in that process, there will be a lot of back and forth on what to do.

"Initially," she said, "the message was, 'Don't wear masks.' There weren't enough masks to go around, and they were needed for high-risk situations. Then we had enough masks, and masks became more important because scientists realized that during the asymptomatic or presymptomatic stage, you could still transmit the virus."

Getting the Message Out 

Because the science on COVID-19 has been confusing, Weatherhead feels it is her duty as a scientist to explain the evolution of the scientific thinking to the general public. She talks regularly with local and regional media about protective measures against the virus.

One of her target audiences is local businesses, which are front and center in enforcement of local COVID policies. "They have to make sure their employees and their customers comply or they could get fined," she said.

A local approach may be the most effective. A study released in May found that messages about the threat of COVID-19 were more likely to convince people to wear masks when the focus of the message was on "your community" rather than "you," "your family," or "your country."

Marvasti is also getting the word out about the science of COVID-19. As "Dr Shad," he speaks out on his website and blogs, and he has appeared on TV. He is a strong advocate of mandating public health guidelines.

"Wearing a face mask is part of our civic duty to help prevent the spread of the coronavirus," he said. "There should be some fine in place for people who don't wear masks. If you don't enforce it, it won't happen."

In July, Monks helped organize an advertising campaign called "Got Mask Oklahoma?," which is backed by the medical association, physician specialty organizations, and the state hospital association. It features a website that includes pictures, stories of Oklahomans who wear masks, and a section entitled "Mask Myths vs Facts."

In California, Walker makes Facebook posts about the need for people to protect themselves, and she compliments businesses that are enforcing mask policies. "If I can convince just a single person, I'll keep on saying what I think," she said.

Leigh Page is a freelance healthcare writer in Chicago, Illinois.

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