The Work Note

[JustPlainBill]

We've all had it happen --- and it ranges from benign -- "Can I get a note for today for work" to the moderate -- "Can I get a note to cover me for the last 2 days since I didn't go to work and decided to come in today?" -- to the insane -- "Can I get a note for work until next Monday" and it's your last appointment Monday night ---

How do you handle them?

I had a patient present as an on-call for what turned out to be a URI -- coughing, blowing snot, running around the exam room saying they were about to throw up, etc. -- had taken some OTC phenylephrine so the BP was jacked higher than I like for steroids so it was 5 days of abx. Upon checkout, patient requested a work note to cover for 1 week off. I declined and gave them that night since they worked nights. Patient leaves the office stating they'll contact their PCP tomorrow to get the week.

So I'm in the chart today following up on something when I notice a note was issued under the PCP's signature block giving them from yesterday until tomorrow off -- I stopped by to see what was up and was told that per patient, a pet ate the physical antibiotic so they couldn't start the medication and thus they needed meds resent and a new note covering for another day.

I just walked off shaking my head ----

What's your practice?

---

Members don't see this ad.

 

[surrender903]

if someone asks for a note, i usually give it to them. as long as i have seen them. if i havent seen them ill say "patient under my care." its their time and days they are burning through.

pick your battles i guess?

 

[JustPlainBill]

if someone asks for a note, i usually give it to them. as long as i have seen them. if i havent seen them ill say "patient under my care." its their time and days they are burning through.

pick your battles i guess?

But do you normally give them however long they want off? I've had people with a minor sniffle ask for a note to cover them for a week off of work. My practice up to this point has been to give them what I reasonably think they need and what I would be willing to do myself. Yeah, ok you've got a cold -- stay home the rest of today and you should be ok to go back tomorrow. It'll suck and you'll feel lousy but you can work. You've been throwing up for 3 days and it's Wednesday and I need to give you IVF -- ok, you're out until Monday -- I want you rested and rehydrated and walking around not dizzy for a day before I send you back. that sort of deal. Now I'm rethinking that into more of a "it's on you -- I"ll give you what you want in terms of note coverage but if I'm ever asked, I'll tell the truth -- It's what they asked for -- no I didn't think they were that sick".

 

[simpler2]

if someone asks for a note, i usually give it to them. as long as i have seen them. if i havent seen them ill say "patient under my care." its their time and days they are burning through.

pick your battles i guess?

Agree with picking battles. There are many of these non-medical decisions that are regulated to PCPs of the world. I generally enter medical facts and fill out whatever is requested. If you are uncomfortable with stating patient NEEDS multiple days off for sickness, I suggest your write something like "Patient was seen and evaluated [date seen] in my clinic. They have requested [number of days/dates patient wants off]. Please allow for time off as appropriate. " If there employer is strict they may not like it but I find even letters with such vague language are often readily accepted.

 

[deleted87716]

My first rule is no work note unless I've seen you (so, don't just call and ask for one...you won't get it.)

For acute problems, I'll give somebody a note for a reasonable length of time, based on their illness. Rarely is that going to be more than an a few days. If it's a week or more, I'll have them make a follow-up appointment at the end of that time period to make sure they're well enough to return to work.

 

[VA Hopeful Dr]

I give them whatever they want. It's my passive-aggresive way of protesting being forced into the employer/employee relationship in the first place.

 

[FrustratedFamDoc]

My first rule is no work note unless I've seen you (so, don't just call and ask for one...you won't get it.)

For acute problems, I'll give somebody a note for a reasonable length of time, based on their illness. Rarely is that going to be more than an a few days. If it's a week or more, I'll have them make a follow-up appointment at the end of that time period to make sure they're well enough to return to work.

Same for me. I do have a few that I know as soon as I see their name on my schedule for a work in, I know the routine. I pick my battles. What really gets me is the FMLA requests when they've had something short and self limited.

 

[simpler2]

Same for me. I do have a few that I know as soon as I see their name on my schedule for a work in, I know the routine. I pick my battles. What really gets me is the FMLA requests when they've had something short and self limited.

I especially love how Walmart and a few others essentially have taken away the ability of their local store to handle even 2 days of sick request and send all requests through 3rd party companies. I know that lawmakers would be pleased to see FMLA being used for sinusitis/bronchitis lasting under a week...that's what FMLA was intended for, right?

 

[cabinbuilder]

But do you normally give them however long they want off? I've had people with a minor sniffle ask for a note to cover them for a week off of work. My practice up to this point has been to give them what I reasonably think they need and what I would be willing to do myself. Yeah, ok you've got a cold -- stay home the rest of today and you should be ok to go back tomorrow. It'll suck and you'll feel lousy but you can work. You've been throwing up for 3 days and it's Wednesday and I need to give you IVF -- ok, you're out until Monday -- I want you rested and rehydrated and walking around not dizzy for a day before I send you back. that sort of deal. Now I'm rethinking that into more of a "it's on you -- I"ll give you what you want in terms of note coverage but if I'm ever asked, I'll tell the truth -- It's what they asked for -- no I didn't think they were that sick".

Anything off over 3 days puts you into FMLA territory. I generally only give 5 days off if they test POS for influenza and its a public safety issue. I call bull**** on the kids who hate school and don't want to go back and who are milking the system. I also call it on the lazies who just don't want to work. I have more leeway in urgent care and generally don't give retroactive work notes and generally for cold/sinus/bronchitis I give the day they are seen. Hard core I suppose but just like the drug seekers, I get the "I hate school, I don't want to work" group too so I keep it at a minimal.

 

[JustPlainBill]

Same for me. I do have a few that I know as soon as I see their name on my schedule for a work in, I know the routine. I pick my battles. What really gets me is the FMLA requests when they've had something short and self limited.

So I heard this from one of our senior physicians -- people are now asking for FMLA (and some companies require it) so that they can protect their PTO time; If they can get FMLA paperwork for the visits for chronic conditions filled out, it doesn't count towards their PTO days off. I actually had a patient demand 5 days per month FMLA paperwork to be filled out for a condition for which they were nonadherent to the treatment plan. I said no and we went through multiple day phone tag before they finally made an appointment ostensibly about something else but then we spent the majority of the visit going back and forth with them trying to convince me to do this --- It was a millennial who wasn't used to being told,"No" --- they then went back to their PCP the next week and quit seeing me for on-call and/or f/u --- Nuts.

 

[ThoracicGuy]

So I heard this from one of our senior physicians -- people are now asking for FMLA (and some companies require it) so that they can protect their PTO time; If they can get FMLA paperwork for the visits for chronic conditions filled out, it doesn't count towards their PTO days off. I actually had a patient demand 5 days per month FMLA paperwork to be filled out for a condition for which they were nonadherent to the treatment plan. I said no and we went through multiple day phone tag before they finally made an appointment ostensibly about something else but then we spent the majority of the visit going back and forth with them trying to convince me to do this --- It was a millennial who wasn't used to being told,"No" --- they then went back to their PCP the next week and quit seeing me for on-call and/or f/u --- Nuts.

At least you don't have to deal with that special snowflake anymore...

 

[JonMonkey]

For me I think it depends on my setting and the person. For starters they must have seen me to get a note and if they are someone that I trust I will be a little more lenient. If I am in my primary care setting I will give them a note if it is reasonable, ie you were out Monday and Tuesday and see me on Tuesday because you were unable to get in on Monday, I will cover both days. Same goes if I am in my sports clinic, ie I see you for a new fracture and you ask for a few days off, I will usually cover that. If the request is unreasonable, ie you see me on Friday and ask from the past 5 days, then I tell them that I will give them a note stating that they saw me on the date of service for XYZ diagnosis.