Doctors and Sick Leave

A patient recently disappeared after I suggested that I might not provide a written statement of inability to work for the employer. I believe that meaningful work can support mental health, and I worry about patients suffering from mental disorders with too much unstructured time on their hands. Work can involve stress, but the patient can benefit greatly from learning to face and manage it rather than running away from it. I wonder how many patients give low ratings to physicians who refuse to get them off work.

Sometimes, of course, mental illness, or the drugs used to treat it, can lead to risk that the worker will make costly mistakes or even endanger others. But should we expect the treating physician to weigh in on such matters, or should the employer retain their own physician to advise them after the employer provides a full job description?

When a treating physician takes on the role of determining whether the patient qualifies for sick leave or disability it can damage the physician’s relationship with the patient. If the physician refuses to “sign the form,” the patient may seek treatment elsewhere, but if the physician acquiesces, apparent failure of future treatment interventions may raise doubts since the patient has an incentive to stay sick in order to avoid work, or to collect compensation.

By advising the employer that the patient cannot work the physician also becomes the employer’s agent. A physician should only work for the patient. One can work around this dilemma by providing the patient a written statement documenting the physician’s recommendation to the patient: “Mr. Jones, I recommend that you stop work for 1 week.” The patient then has the option of providing a copy of the statement to their employer.

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