Sick Notes off Work/School.

In Editorial, Opinion by Edmund Kwok1 Comment

The health care professions have finally begun to revolt. Over the recent years, medical associations have mustered up the courage to publicly denounce the value of having employees and students alike dragging their sick bodies into a doctor’s office (or *gasp*, an Emergency Room!) for the sole purpose of obtaining a sick note. The Ontario Medical Association officially issued their plea early this year, and Doctors Nova Scotia quickly followed suit. And for the first time, an individual physician has started to take action by attempting to charge employers for sending their employees into the office for sick notes off work.

Sick notes: Why?

The arguments against the Sick Note are solidly presented by the above linked articles – why are we making an already strained health care system the policing force for employee sickness? Why do individuals have to “prove” that they were sick by the means of an unnecessary doctor’s visit?

From a physician’s point of view, it is almost impossible anyways to validate the length of a patient’s full illness course from a single visit. Often it is retrospective: the patient would come in on Day “x” of their illness, or many times after recovery, but requesting a Sick Note that extends over past & future dates. Everyone recovers differently from even the same simple viral illness and, as *ahem* omnipotent as physicians are, they simply cannot provide the “proof” that employers seem to want.

The UK has moved away from the concept of a Sick Note to something called a Fit Note – akin to the forms many of us fill for patients presenting with physical injuries acquired on the job – that attempts to shift the focus away from proving if a patient was truly sick retrospectively, to something slightly more useful such as describing prospectively a patient’s fitness to return to work. (Note: in Ontario at least, physicians DO get reimbursed for this service when it comes to physical work-related injuries, but not for other illnesses)

The problem is again, physicians aren’t exactly seers who can predict the future. Often, doctors have no insight into the details pertaining to each individual job and its requirements, and thus make for very poor decision-makers on future “fitness” to return to any particular position.

Ideally, the negotiation should be between the person who is actually feeling the symptoms (i.e. the sick employee) and the person who knows what is required of the job (i.e. the employer) … if the employee wakes up feeling too sick to go and perform in their workplace as expected by the employer, then he/she probably is “too sick” to go. Obtaining a doctor’s note at some single time point in the course of the illness does not add any value to that daily and evolving decision.

And it certainly should not be used as a policing mechanism.

Moving forward

It is a brave step for the Nova Scotian doctor to start charging employers for Sick Notes, and probably one in the right direction. Unfortunately, until it becomes a blanket policy across the board, patients will likely end up visiting other clinics and/or ERs for medically-unnecessary Sick Notes.

Edmund Kwok

Edmund Kwok

Emergency Medicine. Quality Improvement. Patient Safety. Change Management. Healthcare Administration.

Frontdoor 2 Healthcare

Frontdoor2Healthcare, founded by Dr. Edmund Kwok in 2012, provides editorial and commentary on issues affecting Canadian healthcare from the emergency department’s “front door” perspective. Frontdoor posts allow for open sharing of the diverse opinions and perspectives of emergency physicians from across the country.

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