An Ethical Conundrum: The Request for a ‘Doctor’s Note’

Posted on Tue, Nov 10, 2015
An Ethical Conundrum: The Request for a ‘Doctor’s Note’

By Adam Corley, MD
“I’m just here for a doctor’s note.” I hear this “complaint” several times a month in my practice as an ER physician. In an attempt to have an excused absence, many patients seek unnecessary medical consultation to obtain the prized doctor’s note excusing them from school or work.
For companies that offer paid time off for illness and injury, it’s unclear to me how anyone benefits by requiring third-party validation that the beneficiary was indeed not feeling well. If time off is a benefit of employment, why is anyone concerned if the employee who used it actually felt ill?
If the intent of a mandatory doctor’s excuse is to ensure the well-being of the employee or student, then the policy seems unduly paternalistic and Draconian. The individual employee, parent and patient should make their own decisions as to when, if ever, their illness requires medical attention. An arbitrary rule requiring a doctor visit for a minor illness seems to add little to the patient’s recovery.
If the doctor’s note policy is designed to minimize exposure to contagious illnesses, I advise the development of a company policy regarding return to work readiness.  Although a doctor’s visit might be suggested at some point in the algorithm, it wouldn’t be necessary in most cases.
As far as contagious illnesses go, I’m not sure that it’s advisable from a public health standpoint to require otherwise healthy patients with a viral illness to seek medical care. Other sicker patients in the office, clinic or hospital may become exposed to the virus and become seriously ill.
For healthy people with episodic illnesses like a cold or gastroenteritis, the best treatment is usually to stay home, stay hydrated and rest. Although a visit to the doctor or emergency department may become necessary if the illness progresses or if there are extenuating circumstances, it’s not generally needed for minor maladies.
The average cost for an emergency room visit is $383, according to Blue Cross Blue Shield of Texas. If you have a serious or life-threatening condition, $383 seems like a bargain to me. However, it seems like a large and avoidable expense if paid to receive unnecessary medical evaluation. For the uninsured or those with a large deductible or co-pay, this can be a significant burden.
I honestly don’t know what to do with many of these work note requests. If a patient tells me “I feel fine now but felt bad yesterday, and I need a doctor’s note for work,” I don’t know what my role is. Write a note asking for the patient to be excused from work based on what she told me? Deny the note because I lack objective evidence that she was ill yesterday?   
Generally, I just believe that the patient has or recently had a minor illness. I take a history and do a physical exam on the off chance I stumble onto a significant finding. I ask them if they feel like they need anything other than the work note and if not, I dutifully fill one out and send them on their way to work or school.
Let’s let patients decide when a visit to the doctor’s office or emergency department is necessary and how to spend their healthcare dollars or benefits. A mandatory doctor’s excuse policy is expensive, burdensome and has little benefit to the patient or the public.

Dr. Adam Corley is a practicing emergency physician with more than 10 years of clinical and leadership experience. Dr. Corley serves as Executive Vice President for EmCare’s West Division. He also serves as the medical director for several EMS services and the Anderson County Texas Sheriff’s Department. Dr. Corley lectures and writes on a variety of topics, including decision science and behavioral economics, management of disruptive behavior in healthcare, conflict resolution and healthcare leadership.

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