Keeping the gates

“Doc, can I get a sick note for work? I need one if I’m off for more than 3 days.”

“But Bob, you don’t look sick.”

“You should have seen me last week. I could hardly get out of bed.”

“Well, why didn’t you come then?”

“I just told you—I was too sick.”

As a GP I get numerous requests like this one. Like many of you, I wonder what the best solution is. Should I give him the note, and if so whom should I charge? Should I bill MSP for an office visit or should I have seen him last week even though it wasn’t necessary? The patient is just doing what he has been told by his employer. The bigger question for me is, what has this got to do with the practice of medicine?

I became a physician to take care of people and try to help them where I can. I didn’t go to medical school and study for many long hours so that I could write notes and fill out forms, but this is what seems to be occupying more and more of my time. I realize I can charge for many of these tasks, but often the expense is born by my patients and not the requesting entity. 

I can rationalize that I am the person best suited to fill out many of the insurance forms that come across my desk, but I get frustrated with many of the others that some official has decided should be my duty to complete.

For example, who nominated me to sign a form stating that someone is “physically and mentally fit” to work in various environments? Why do family physicians get to decide who uses HandyDART or gets a disability parking pass? Should I be the one who decides if a patient is qualified for the disability tax credit? Many of these requests put physicians in an uncomfortable position because as our patient’s advocate we feel pressure to help our patients and acquiesce. 

Many extended health plans require a physician’s referral for orthotics, massage, physiotherapy, counseling, and more. Often patients are already accessing these services when the request comes. How do you tell patients that you don’t think they need a massage, which makes them feel better, or counseling sessions to help them deal with life’s ups and downs?

It appears that when drafting a new form or requirement for their employees or members, many businesses and organizations go with the fallback position of involving the family physician. Again, I realize this is a source of income for many doctors, but in today’s world of general practitioner shortages, is this the best use of a limited resource? I recently completed a randomized double-blind study on this issue (i.e., I scribbled on a yellow sticky note) that revealed that I complete about 20 of these types of tasks in a week, many of which are associated with an office visit. I’m not sure what the best solution is, but allowing physicians to see problems that require medical evaluation and not just a signature might go a long way toward freeing up GPs so that unattached patients can actually find a doctor.
—DRR