Emotional Support Animals , applications, approvals, $100 per patient?

[crazybrancato]

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Members don't see this ad.

Have you guys seen these ads from companies looking for physicians, to sign on applications for Emotional Support Animals (ESA) , offering something like $100 a pop, essentially just like chart review (telemedicine), the physician never has to see the patient. Legit? Any one dabbled in this?

 

[rokshana]

Have you guys seen these ads from companies looking for physicians, to sign on applications for Emotional Support Animals (ESA) , offering something like $100 a pop, essentially just like chart review (telemedicine), the physician never has to see the patient. Legit? Any one dabbled in this?

Please do not add to the chihuahuas, pigs, peacocks that are on planes these days...

 

[IMGASMD]

Where do I sign up? Do I need a certificate to certified that I am trained to pick an emotional animal for the patient? As long as I don’t have to submit to insurance company for approval? I am game.....

 

[Trogghunter]

I wonder if there is some liability to it? I looked at the websites for people to get in touch with the doctors or providers that can certify the pets are required for mental health reasons. The patient needs to have some sort of psychiatric problem, so obviously that should not be falsified, but I wonder if the doc can be held liable if an animal attacks someone.

 

[IMGASMD]

I wonder if there is some liability to it? I looked at the websites for people to get in touch with the doctors or providers that can certify the pets are required for mental health reasons. The patient needs to have some sort of psychiatric problem, so obviously that should not be falsified, but I wonder if the doc can be held liable if an animal attacks someone.

Who actually picks the animal? I need a tiger because I want a strong animal? I want a llama, or alpaca, fine, maybe a camel... I have a good one, elephant! I want an elephant as my emotional support!

 

[InvestingDoc]

I once signed a form and someone in my city and they must have put it on facebook that I'm doing that now and I kid you not we had like 40 calls that month for me to sign forms for their animal.

I then created a policy that I require them to visit a psychologist and have a letter from them agreeing that they need a support animal.

We also had to get a bit more tough on our policy in our clinic after someones emotional support animal bit another patient in the waiting room.

My lawyer had to get involved, I had to call my liability insurance company. Nothing ever came of it...yet, but what a **** show.

#edit, since I've created the policy, not a single person has followed through with the psychologist referral in order to do the paperwork and have come back to me to have their form signed.

 

[hamstergang]

Legit?

Emotional support animals are not legit. They are simply a tool people use to get their pets places that pets are otherwise not allowed. Sure, having a pet helps people feel good, but this is not a medically indicated treatment for depression or anxiety. Having your rent cut in half would similarly reduce stress, but no one's advocating that as a medical treatment.

 

[hamstergang]

I wonder if the doc can be held liable if an animal attacks someone.

As far as I'm aware, this has never happened. In the somewhat recent case where there was a lawsuit against an airline for an ESA attack, the psychiatrist who signed off on the ESA was not included in the suit.

 

[Siggy]

If only there was another name for an emotional support animal. You know... like "pet."

 

[crazybrancato]

As far as I'm aware, this has never happened. In the somewhat recent case where there was a lawsuit against an airline for an ESA attack, the psychiatrist who signed off on the ESA was not included in the suit.

My understanding is that the physician is not responsible for the activities of the animal. The ESA letter is simply a recommendation (not a prescription, no a diagnosis, not a treatment plan). It's like recommending a handicapped placard. If the patient uses the parking pass illegally, the physician is not to blame. Or recommending a scooter. If the patient rolls over someone's foot with the scooter, the patient is liable, not the doctor.

Anyway, this is how the company is pitching it to me. I'm simply putting my name on a recommendation letter.

In any case, thank you all for the input. Can I ask the moderators to move this to the Psychiatry thread, I'd like to get their input as well (they probably have more experience with this kind of stuff).

 

[IM-2019]

Emotional support animals are not legit. They are simply a tool people use to get their pets places that pets are otherwise not allowed. Sure, having a pet helps people feel good, but this is not a medically indicated treatment for depression or anxiety. Having your rent cut in half would similarly reduce stress, but no one's advocating that as a medical treatment.

ESA laws only guarantee access in apartments and on planes, both places that usually accommodate animals anyway but often charge pretty high fees to do so. There is actually decent evidence IMO that ESAs are beneficial for mental health (albeit not double-blinded RCTs since those would be essentially impossible with animals), and there is minimal risk of harm in prescribing them, since the worst that can happen is someone abusing the system to save on pet fees, and the potential benefit is helping someone cope with their mental illness better.

Airlines are actually cracking down and making ESAs dogs and cats only for the most part now, and ESAs aren't guaranteed access to other public spaces like restaurants the way that service animals are, so I think we are starting to see some needed reforms coming through.

All of the websites which are essentially just selling ESA letters are rather unethical and worsening the stigma against people with legitimately prescribed ESAs. Writing an ESA letter when you're not the one actually caring for the mental illness seems pretty shady to me, even if it's legal.

 

[deleted480308]

ESA laws only guarantee access in apartments and on planes, both places that usually accommodate animals anyway but often charge pretty high fees to do so. There is actually decent evidence IMO that ESAs are beneficial for mental health (albeit not double-blinded RCTs since those would be essentially impossible with animals), and there is minimal risk of harm in prescribing them, since the worst that can happen is someone abusing the system to save on pet fees, and the potential benefit is helping someone cope with their mental illness better.

Airlines are actually cracking down and making ESAs dogs and cats only for the most part now, and ESAs aren't guaranteed access to other public spaces like restaurants the way that service animals are, so I think we are starting to see some needed reforms coming through.

All of the websites which are essentially just selling ESA letters are rather unethical and worsening the stigma against people with legitimately prescribed ESAs. Writing an ESA letter when you're not the one actually caring for the mental illness seems pretty shady to me, even if it's legal.

Lots of things a beneficial for mental health. Doesn’t mean someone’s animal should be forced into private property

 

[xoggyux]

Hardly anything we do is without consequence. At some point, something that goes unnoticed for decades gets out of control and it is abused and catch the eye of a few people and next thing you know something comes back to bite you in the ass. My approach to this is the same as my approach to any other thing if it does not fit within my medical judgment, knowledge, and zone of comfort, I do not do it. Signing some sort of certificate/paper without me seeing the patient is a no-no. I feel I would be "certificating" that the patient has some sort of psychiatric condition/need and by extension, I would not be offering the appropriate treatment for such condition, because as far as I know, a companion pet is not a prescription to any medical problem that I know.

I could see myself agreeing to sign a paper for someone, for instance, that was severely depressed and we tried a bunch of stuff, the patient is on medication with little help and had a significant improvement after getting a small dog or cat. But this kind of event would be very sporadic and far in between/rare to consider it a business or something along those lines. It has not happened as of yet.

This not necessarily because of me thinking that this is some kind of treatment, but rather because the patient does, and it would have little to no harm. Kind of along the same lines of "you are telling me that every time that you eat a dozen hazelnuts in the morning, your arthritis pain goes away for the rest of the day? Perfect! keep doing that then".

My understanding is that the physician is not responsible for the activities of the animal.

The medical-legal aspect is not my area of expertise, but at the very least it would not be favorable to you if something like this gets out of control.
Guy with PTSD, Antisocial personality, Criminal records, gets a license for a large dog, such as a Doberman. Next thing you know it is all over the news when the Doberman bitted the face of a 4-year-old and disfigured her for life not to mention put her in the ICU for 2 months and everyone is after the idiot that thought it was a good idea to pair this dog with his owner, or why the owner's doctor did not actually provide psychiatric care and instead simply gave him a dog, or something along those lines. And although like I said, the legal aspect is beyond my area of expertise, I could not say if you can legally get in trouble, I can see multiple scenarios were simply "bad rep" can get you in trouble not to mention the ethics of it all.

 

[deleted480308]

Hardly anything we do is without consequence. At some point, something that goes unnoticed for decades gets out of control and it is abused and catch the eye of a few people and next thing you know something comes back to bite you in the ass. My approach to this is the same as my approach to any other thing if it does not fit within my medical judgment, knowledge, and zone of comfort, I do not do it. Signing some sort of certificate/paper without me seeing the patient is a no-no. I feel I would be "certificating" that the patient has some sort of psychiatric condition/need and by extension, I would not be offering the appropriate treatment for such condition, because as far as I know, a companion pet is not a prescription to any medical problem that I know.

I could see myself agreeing to sign a paper for someone, for instance, that was severely depressed and we tried a bunch of stuff, the patient is on medication with little help and had a significant improvement after getting a small dog or cat. But this kind of event would be very sporadic and far in between/rare to consider it a business or something along those lines. It has not happened as of yet.

This not necessarily because of me thinking that this is some kind of treatment, but rather because the patient does, and it would have little to no harm. Kind of along the same lines of "you are telling me that every time that you eat a dozen hazelnuts in the morning, your arthritis pain goes away for the rest of the day? Perfect! keep doing that then".

The harm is it then being used to force other people to put up with their dog/cat

 

[xoggyux]

The harm is it then being used to force other people to put up with their dog/cat

You can say the same thing about a baby, loud music or even perfume. If my hypothetical depressed patient shows improvement with a dog, I think the short inconvenience to a few others is a reasonable trade-off.

Think of it as a medicine that causes flatulence, you are forcing others to your patient's farts...Or a skin cream for psoriasis that stinks... Would you stop giving the med to your patient if it is working for him/her?

 

[rokshana]

Hardly anything we do is without consequence. At some point, something that goes unnoticed for decades gets out of control and it is abused and catch the eye of a few people and next thing you know something comes back to bite you in the ass. My approach to this is the same as my approach to any other thing if it does not fit within my medical judgment, knowledge, and zone of comfort, I do not do it. Signing some sort of certificate/paper without me seeing the patient is a no-no. I feel I would be "certificating" that the patient has some sort of psychiatric condition/need and by extension, I would not be offering the appropriate treatment for such condition, because as far as I know, a companion pet is not a prescription to any medical problem that I know.

I could see myself agreeing to sign a paper for someone, for instance, that was severely depressed and we tried a bunch of stuff, the patient is on medication with little help and had a significant improvement after getting a small dog or cat. But this kind of event would be very sporadic and far in between/rare to consider it a business or something along those lines. It has not happened as of yet.

This not necessarily because of me thinking that this is some kind of treatment, but rather because the patient does, and it would have little to no harm. Kind of along the same lines of "you are telling me that every time that you eat a dozen hazelnuts in the morning, your arthritis pain goes away for the rest of the day? Perfect! keep doing that then".


The medical-legal aspect is not my area of expertise, but at the very least it would not be favorable to you if something like this gets out of control.
Guy with PTSD, Antisocial personality, Criminal records, gets a license for a large dog, such as a Doberman. Next thing you know it is all over the news when the Doberman bitted the face of a 4-year-old and disfigured her for life not to mention put her in the ICU for 2 months and everyone is after the idiot that thought it was a good idea to pair this dog with his owner, or why the owner's doctor did not actually provide psychiatric care and instead simply gave him a dog, or something along those lines. And although like I said, the legal aspect is beyond my area of expertise, I could not say if you can legally get in trouble, I can see multiple scenarios were simply "bad rep" can get you in trouble not to mention the ethics of it all.

I have seen people have dogs to detect hypoglycemia...before cgms it would have been the only way for someone with hypoglycemic unawareness to know when their sugars drop to dangerous levels.

 

[rokshana]

You can say the same thing about a baby, loud music or even perfume. If my hypothetical depressed patient shows improvement with a dog, I think the short inconvenience to a few others is a reasonable trade-off.

Think of it as a medicine that causes flatulence, you are forcing others to your patient's farts...Or a skin cream for psoriasis that stinks... Would you stop giving the med to your patient if it is working for him/her?

Yes, but other than the perfume, people aren’t allergic to them...can’t have peanuts on a plane but can have other allergens?

 

[deleted480308]

You can say the same thing about a baby, loud music or even perfume. If my hypothetical depressed patient shows improvement with a dog, I think the short inconvenience to a few others is a reasonable trade-off.

Think of it as a medicine that causes flatulence, you are forcing others to your patient's farts...Or a skin cream for psoriasis that stinks... Would you stop giving the med to your patient if it is working for him/her?

I’ve never given a medicine to someone that pissed on the carpet or bit their neighbor

Your letter isn’t for “giving them medicine”. Your letter is solely for them to wave at people who don’t want their dog around.

 

[xoggyux]

Yes, but other than the perfume, people aren’t allergic to them...can’t have peanuts on a plane but can have other allergens?

Here is the thing,

Yes, but other than the perfume, people aren’t allergic to them...can’t have peanuts on a plane but can have other allergens?

Ok so then you would agree and treat perfume in exactly the same way as you seem to suggest of using animals I take right? Via laws, ordinances, guidelines, and rules, nobody should be able to expose anyone else to a fragrance such as deodorant, perfume, strong soap smells, detergents etc.

I have allergies to most fragrances/dust/pollen, for instance, I spend 70% of the year sneezing/coughing due to people's predilection to hide behind fragrances It is irritating, especially when they do it in a hospital. This is, however, a problem that should be dealt with via personal responsibility and not something where you skip personal responsibility and go straight for some kind of rule/restriction.

If your kid as autism and his behavior in a plane is expected to be 7x better if his puppy is next to him/her in a cage I think he/she should get to keep it. It is part of your personal responsibility to make the arrangments prior (e.g. buy the right ticket w/ onboard pet, etc) it is the airline's responsibility to make accommodations. If another passenger has severe allergies it is also his responsibility to do similar arrangements.

It does not have to be a kid with autism either. I have personally flown with people that had panic attacks in the plane. If a person with panic disorder or severe anxiety has one of such animals and they want to bring it... honestly I think they should be able to.
Again, you cannot ignore personal responsibility and that is the point!

When was the last time they stopped you, family, a friend from boarding the plane when you or family/friends had the flu? Do you realize that exposing 200+ passengers to a disease? Again? who makes the decision to not allow a sick passenger to fly. The flight attendant? the pilot? the person that checks your ticket before you board? Where did they get their medical credentials, how do they determine that disease X can be contagious but disease Y is not? Are you going to mandate every passenger gets a doctor's check 24h prior to boarding? Things can get pretty ridiculous pretty fast if you simply try to control everything via some sort of written rule and assume people not to use any degree of personal responsibility. It is our responsibility to educate our patients about their illness and how this might affect others so that they, in turn, can take the appropriate RESPONSIBLE steps to minimize other people's discomfort.

If you read carefully my first post on the topic you'd see I am not a fan of this "emotional support pet" BS. I think it is mostly a wishy-washy excuse to allow some people to get away with what they want. Similar to the whole medical marijuana craze. That being said, I caution myself and others against jumping to a quick automated conclusion based simply on whatever pre-conceived biases we might have.

I’ve never given a medicine to someone that pissed on the carpet or bit their neighbor

Your letter isn’t for “giving them medicine”. Your letter is solely for them to wave at people who don’t want their dog around.

Again, that is not the point. Your baby can take a ****/piss/vomit on their sofa, carpet, car or your loud music might trigger a panic attack on your neightboor with PTSD. This all goes back to personal responsibility. If your emotional parrot took a **** on your neighbors' carpet, you apologize, pay for the cleaning/replacement/etc and invite your neighbor to dinner in your house and offer him/her a nice glass of wine.

 

[deleted480308]

Again, that is not the point. Your baby can take a ****/piss/vomit on their sofa, carpet, car or your loud music might trigger a panic attack on your neightboor with PTSD. This all goes back to personal responsibility. If your emotional parrot took a **** on your neighbors' carpet, you apologize, pay for the cleaning/replacement/etc and invite your neighbor to dinner in your house and offer him/her a nice glass of wine.

Weird how no where in your analogy did mention the govt showing up and fining your neighbor if they don't want you coming over anymore because they don't want to deal with animals crapping on their property

 

[xoggyux]

Weird how no where in your analogy did mention the govt showing up and fining your neighbor if they don't want you coming over anymore because they don't want to deal with animals crapping on their property

Oh please, stop being so melodramatic. Nobody is fining you for not letting your neighbors pet into your house. If you are talking about an open front yard? Guess what, you cannot do much against non-"emotional" (regular) pets either, about stray and wild animals either cats, racoons, pidgeons, ducks and lizzards either. If you have 1 particular neighbor that is a nuance, get a surveillance camera, record the activity happening and politely confront your neighbors to pick the crap up and put it in the trash or to not walk his pet into your yard. If it does not work, talk to other neighbors to see if this is also bothering them (chances are it will), and do the same thing but this time with the help of the other neighbors. If you are the only one being annoyed by this, chances are you chose the wrong place to live. There are a million and one ways to deal with crap that bothers you personally.

 

[deleted480308]

Oh please, stop being so melodramatic. Nobody is fining you for not letting your neighbors pet into your house. If you are talking about an open front yard? Guess what, you cannot do much against non-"emotional" (regular) pets either, about stray and wild animals either cats, racoons, pidgeons, ducks and lizzards either. If you have 1 particular neighbor that is a nuance, get a surveillance camera, record the activity happening and politely confront your neighbors to pick the crap up and put it in the trash or to not walk his pet into your yard. If it does not work, talk to other neighbors to see if this is also bothering them (chances are it will), and do the same thing but this time with the help of the other neighbors. If you are the only one being annoyed by this, chances are you chose the wrong place to live. There are a million and one ways to deal with crap that bothers you personally.

the entire point of the letter is that people want to force landlords, transportation, employers and others to put up with their pets

 

[xoggyux]

the entire point of the letter is that people want to force landlords, transportation, employers and others to put up with their pets

Let me ask you this. Do you have the same problem with a service dog for a blind person?
Look if you are just annoyed at the nuisance of the random joe that wants to use it as a preferential treatment... those old ladies that take their purse dogs everywhere or the family downstairs that can barely feed their kids but spend 3k dollars pampering their bulldogs I get it and I agree with you. But be careful of casting a wide net blindly. But again, that is an issue with personal responsibility and you cannot force people to behave in a civil way, you can only teach them.

 

[rokshana]

Let me ask you this. Do you have the same problem with a service dog for a blind person?
Look if you are just annoyed at the nuisance of the random joe that wants to use it as a preferential treatment... those old ladies that take their purse dogs everywhere or the family downstairs that can barely feed their kids but spend 3k dollars pampering their bulldogs I get it and I agree with you. But be careful of casting a wide net blindly. But again, that is an issue with personal responsibility and you cannot force people to behave in a civil way, you can only teach them.

Service dog and emotional support animals are NOT the same thing...service animals are specifically trained to be around people yet not interact with them and thoroughly trained to serve their role...and accommodating them is required by the ADA...NONE of that is true for these pets...if and when they are, then it will be different.

 

[deleted480308]

Let me ask you this. Do you have the same problem with a service dog for a blind person?
Look if you are just annoyed at the nuisance of the random joe that wants to use it as a preferential treatment... those old ladies that take their purse dogs everywhere or the family downstairs that can barely feed their kids but spend 3k dollars pampering their bulldogs I get it and I agree with you. But be careful of casting a wide net blindly. But again, that is an issue with personal responsibility and you cannot force people to behave in a civil way, you can only teach them.

but you are advocating a letter that does actually force property owners to put up with these animals

And no, I don't think the ADA should be forcing service animals either but let's not even begin to equate the level of training and need of a service dog with the farce that is the emotional support animal

 

[xoggyux]

Service dog and emotional support animals are NOT the same thing...service animals are specifically trained to be around people yet not interact with them and thoroughly trained to serve their role...and accommodating them is required by the ADA...NONE of that is true for these pets...if and when they are, then it will be different.

Again I think we are having a miscommunication problem here and you are missing the point I'm trying to make. A trained dog does lose their allergic-inducing properties so if you are OK accommodating that dog despite the allergic issues, you cannot use "allergy" as an excuse for all other situations. Don't use a shotgun approach to your objections, if allergies are not your concern, then what is?

Then we get into the lines of whether or not the "emotion support animal" is a real thing. I won't really argue this point because I think it is ultimately irrelevant. Putting your rheumatoid hands into warming mittens might have zero benefits when it comes to disease progression or treatment but if my patient comes to me saying that it alleviates their pain and they think it is helping them, I will encourage them to keep using them until such time as I have good evidence suggesting that they shouldn't.

And yes, 95% of the time it is BS but we all know how inflexible people can get when they are given a checklist of "policy" and "rules and regulation" or "laws" or "ordinances" etc. "But doctor, you forgot to put something for DVT prophylaxis" "LEAVE ME ALONE, PATIENT HAS AN INR OF 3.0 from warfarin due mechanical valve! HE DOES NOT NEED ANY MORE DVT PROPHYLAXIS" "But doctor we need you to at least put SCDs or heparin or Lovenox, or we are going to get in trouble" "GRRRRRRRRRR"!!!

And this has been my point all along, I think we need to do better from an individual personal responsibility and civility point of view.

Tell me, what would be your approach if an established patient of yours. This hypothetical patient was a healthy individual, 3 years ago he was driving and crashed and his daughter in the car died. Since then he has had PTSD, depression, anxiety, panic disorder and he barely ever goes out of his house. Gets panic attacks every time he gets into a car. He has been seen by a psychiatrist, attended psychotherapy, is taking a multitude of psychotropic drugs including benzos PRN. The guy comes to you 3 months after getting a new dog, and he has been able to control his anxiety much better now. He can now ride a car without taking his diazepam if the dog is coming with him. His family is pushing him to go on a vacation trip but he is terrified and anxious about the plane ride, he has not been in a plane since the accident and although it might not be his usual trigger he does not think he will be able to make it on his own. Tell me, do you think it is wrong for this patient to get some sort of accommodation?

but you are advocating a letter that does actually force property owners to put up with these animals

And no, I don't think the ADA should be forcing service animals either but let's not even begin to equate the level of training and need of a service dog with the farce that is the emotional support animal

First, I am not advocating for anything. I'm just discussing a topic from a different point of view.
Second, don't tell me that you just figured out that people abuse everything.... including doctors, abuse every possible thing they can. Handicapped parking decal? Yes, you bet! that also gets abused. Work disability? You bet! Even Doctor's note to not go to work/school. And this is why I say, personal responsibility is the sensible way to tackle this problem. For instance, a previous poster "InvestingDoc" shared the way that he deals with this issue, he took some steps to address the issue in a responsible matter, rather than simply say "NO" to everyone.
The true number of people that might "need" or "benefit" from this is relatively small, small enough that it should not cause any sort of chaos and small enough that it should not inconvenience the vast majority of the public. It is up to us, healthcare providers to responsibly assess if this is required.
Signing such a letter to get rid of the loud annoying lady that just wants it for her pet is definitely a nono, but I don't think I would say no to the guy with PTSD, severe anxiety and panic disorder on medication and psychotherapy that comes to my office saying that the new dog is helping him stay away from benzos while helping him stay calm.
I think there is definite ethical issues with abusing this and probably there could even be legal issues as well as I alluded in my first reply. Therefore, I do not agree with the OP proposition of doing this sort of "pay per certificate scheme" but I do not completely dismiss it either.

 

[deleted480308]

Again I think we are having a miscommunication problem here and you are missing the point I'm trying to make. A trained dog does lose their allergic-inducing properties so if you are OK accommodating that dog despite the allergic issues, you cannot use "allergy" as an excuse for all other situations. Don't use a shotgun approach to your objections, if allergies are not your concern, then what is?

Then we get into the lines of whether or not the "emotion support animal" is a real thing. I won't really argue this point because I think it is ultimately irrelevant. Putting your rheumatoid hands into warming mittens might have zero benefits when it comes to disease progression or treatment but if my patient comes to me saying that it alleviates their pain and they think it is helping them, I will encourage them to keep using them until such time as I have good evidence suggesting that they shouldn't.

And yes, 95% of the time it is BS but we all know how inflexible people can get when they are given a checklist of "policy" and "rules and regulation" or "laws" or "ordinances" etc. "But doctor, you forgot to put something for DVT prophylaxis" "LEAVE ME ALONE, PATIENT HAS AN INR OF 3.0 from warfarin due mechanical valve! HE DOES NOT NEED ANY MORE DVT PROPHYLAXIS" "But doctor we need you to at least put SCDs or heparin or Lovenox, or we are going to get in trouble" "GRRRRRRRRRR"!!!

And this has been my point all along, I think we need to do better from an individual personal responsibility and civility point of view.

Tell me, what would be your approach if an established patient of yours. This hypothetical patient was a healthy individual, 3 years ago he was driving and crashed and his daughter in the car died. Since then he has had PTSD, depression, anxiety, panic disorder and he barely ever goes out of his house. Gets panic attacks every time he gets into a car. He has been seen by a psychiatrist, attended psychotherapy, is taking a multitude of psychotropic drugs including benzos PRN. The guy comes to you 3 months after getting a new dog, and he has been able to control his anxiety much better now. He can now ride a car without taking his diazepam if the dog is coming with him. His family is pushing him to go on a vacation trip but he is terrified and anxious about the plane ride, he has not been in a plane since the accident and although it might not be his usual trigger he does not think he will be able to make it on his own. Tell me, do you think it is wrong for this patient to get some sort of accommodation?


First, I am not advocating for anything. I'm just discussing a topic from a different point of view.
Second, don't tell me that you just figured out that people abuse everything.... including doctors, abuse every possible thing they can. Handicapped parking decal? Yes, you bet! that also gets abused. Work disability? You bet! Even Doctor's note to not go to work/school. And this is why I say, personal responsibility is the sensible way to tackle this problem. For instance, a previous poster "InvestingDoc" shared the way that he deals with this issue, he took some steps to address the issue in a responsible matter, rather than simply say "NO" to everyone.
The true number of people that might "need" or "benefit" from this is relatively small, small enough that it should not cause any sort of chaos and small enough that it should not inconvenience the vast majority of the public. It is up to us, healthcare providers to responsibly assess if this is required.
Signing such a letter to get rid of the loud annoying lady that just wants it for her pet is definitely a nono, but I don't think I would say no to the guy with PTSD, severe anxiety and panic disorder on medication and psychotherapy that comes to my office saying that the new dog is helping him stay away from benzos while helping him stay calm.
I think there is definite ethical issues with abusing this and probably there could even be legal issues as well as I alluded in my first reply. Therefore, I do not agree with the OP proposition of doing this sort of "pay per certificate scheme" but I do not completely dismiss it either.

You misunderstand me. Even if it were medically beneficial, the letters shouldn’t exist.

And signing that letter isn’t like a prescription for med that requires a physician to access. Anyone can buy a pet without a doctor. The entire point of the letter is to force others to tolerate the pet. You say almost no one is impacted but literally everyone the patient flashes that letter at is impacted.

 

[xoggyux]

You misunderstand me. Even if it were medically beneficial, the letters shouldn’t exist.

And signing that letter isn’t like a prescription for med that requires a physician to access. Anyone can buy a pet without a doctor. The entire point of the letter is to force others to tolerate the pet. You say almost no one is impacted but literally everyone the patient flashes that letter at is impacted.

You are right and I agree. Those letters should not exist. Letters to explain to your employer that you were sick in the doctor should not exist either, nor should letters to certify that you have advanced arthritis and need to park in a designated spot so that you don't have to walk a block to the supermarket with your 80 years old arthritic joints. Ideally, we should rely on the word of respectful individuals that would not lie and pretend to have any sort of health issue in exchange for quick convenience.

Most of my patients under 50-years old that are not enrolled in some sort of disability "pseudo-scam" end up asking for a letter saying that they were hospitalized from day x to day y. Why? I have worked multiple jobs and never in my life, not even when I was a teenager, I need to show such a letter. My word was enough, why? because you build trust and a reputation for reliability. Then why is it that many of my patients do ask for it? because they probably are "sick" way too often which in many cases is actually not true.

The reality is that they do exist, and they do for a reason which is that a small number of people can benefit from this. Some healthcare providers are in a unique position to help those people or basically do the equivalent of fraud and do it for $$ or simply to avoid confrontation with a patient that is demanding it. All I am saying is that we have the power to have the train stop with us, that's all. We don't need to cancel all routes, just stop those trains that are going to the wrong destination.

 

[deleted480308]

You are right and I agree. Those letters should not exist. Letters to explain to your employer that you were sick in the doctor should not exist either, nor should letters to certify that you have advanced arthritis and need to park in a designated spot so that you don't have to walk a block to the supermarket with your 80 years old arthritic joints. Ideally, we should rely on the word of respectful individuals that would not lie and pretend to have any sort of health issue in exchange for quick convenience.

Most of my patients under 50-years old that are not enrolled in some sort of disability "pseudo-scam" end up asking for a letter saying that they were hospitalized from day x to day y. Why? I have worked multiple jobs and never in my life, not even when I was a teenager, I need to show such a letter. My word was enough, why? because you build trust and a reputation for reliability. Then why is it that many of my patients do ask for it? because they probably are "sick" way too often which in many cases is actually not true.

The reality is that they do exist, and they do for a reason which is that a small number of people can benefit from this. Some healthcare providers are in a unique position to help those people or basically do the equivalent of fraud and do it for $$ or simply to avoid confrontation with a patient that is demanding it. All I am saying is that we have the power to have the train stop with us, that's all. We don't need to cancel all routes, just stop those trains that are going to the wrong destination.

We're going to disagree on this one. That's fine

 

[xoggyux]

We're going to disagree on this one. That's fine

Cool