Sick Notes
Why would sick notes merit a missive all their own? Why are Family Doctors so fixated on sick notes? Medical Associations across the country and nationally have sick notes as an agenda item when they talk to governments. Can it really be that big an issue?
If it is in this SubStack, you know it is an issue.
The sad truth is that any supervisor of any employee in this country can decide what a Family Doctor’s job is. That’s because so many conversations in Family Doctors offices start off with the phrase, “My [somebody] at work said you need to give me a note for …”
Here’s why (if it even needs explaining) sick notes are a waste of a doctor’s time. In this context, most sick notes are done after the sickness. Here’s a typical conversation between patient and Family Doctor:
MD: What brings you in today?
PT: I need a sick note.
MD: Are you sick?
PT: I had the flu last week. Coughing, sneezing, chills, muscle aches.
MD Sounds like the flu. Are you still sick?
PT: No, I got over it in about three days.
MD: So why do you need a note?
PT: Someone from HR told me I need a note for the three days I was off.
MD: But I didn’t see you while you were off?
PT: I told them that but they [whoever “they” are] still say I need a note.
MD: Well, all I can say is that you saw me today and told me you were sick last week.
PT: No, they say you have to say I was sick last week.
MD: But I didn’t see you last week, so I can’t say that …
The conversation doesn’t end there, but you get the idea. There are cases where folks will have ongoing medical issues that impact their ability to be gainfully employed and notes can be written based on their health status in the moment. Those are rare and not the reason for complaints by doctors about sick notes.
At a Canadian Medical Association (CMA) meeting, there was a panel discussion an Administrative Burden, and sick notes came up. There was a person there representing industry, who basically admitted that businesses use sick notes to manage human resource issues around time off work. It serves no purpose other than (in their minds) to create a barrier that they hope will discourage their employees from taking time off and telling their employer they were sick. It doesn’t accomplish that goal and yet employers persist. The thing is, Family Doctors are not human resource managers and should not be expected to be.
The result, though, is that any employee of the company for which the patient works can decide the job description of a Family Doctor. Since there are little or no rules around sick notes (governments sometimes lift requirements, but they usually don’t ban the practice outright), anyone working for the company can decide what the rules around sick notes are. Some companies require them if only one day is missed, some three days, some a week. When one employee’s superior was told the employee would be incapacitated for weeks, they decided the employee needed to supply a new sick note every Monday until the employee returned to work. Some employers require notes to stay off work for sickness and notes saying the person can return to work.
This is not the CEO of the company making these demands of Family Doctors. Anyone at the company can decide what the Family Doctor is expected to supply. Immediate supervisor, manger, secretary in the Human Resources department, Manager of Human Resources. Anyone can tell the Family Doctor what is needed at what frequency and there is no rhyme or reason to the demands. Just make something up, then tell the employee it is the doctor’s responsibility.
For some employers, a note just will not do. Before returning to work they require a functional assessment to be done. This is a process of examine the condition of the worker in terms of their ability to return to the work they were previously capable of doing. Note the specificity there, not just return to work but to the specific tasks they are expected to perform. These sorts of assessments usually and best done by Occupational Therapist, and Family Doctors, with rare exception, are not trained to perform evaluations of this type. So, why ask a Family Doctor to do it? Because if they ask an Occupational Therapist to do it, the employer would have to pay. They ask Family Doctors to avoid that cost.
Since we are on the issue of cost, employers do not pay for the sick notes they require. Governments don’t pay for them either, even for their own employees. This is an uninsured service. Most Family Doctors are uncomfortable asking patients to pay for notes and do not charge or charge a menial sum.
Human resource management is not a part of any medical curriculum with which I am familiar. I know of no student who went to medical school to fill out retroactive sick notes. Think of the amount of clinic time this takes up that could be spent doing something medically useful. How many appointments with a doctor are wasted on this kind of activity?
How long does it take, how many sick notes does a Family Doctor have to write before they start questioning if sick notes are the reason they worked so hard to get through medical education?