excuse from work requests

[AndyDufrane]

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so I recently saw a 30 something LBP pain, patient was not referred to me, came on his own, pain started 3 weeks ago, has not been to work for the last 3 weeks, taken off work by pcp, the day he presented to me, he was supposed to go back to work the next day (which was a Friday), so I wrote him a one day excuse until he could see his pcp and I explained to patient and his wife that I would write a one day excuse from work but then they need to follow up with the provider who originally took him off work, wouldn't you know it, they call the following week Monday asking for an excuse from work and then the next day Tuesday asking for more time off from work, how do I deal with this situation? any input would be appreciated. I thought unless a pcp referred to you, the taking on/off work was up to the original provider who takes a patient off work, any good logical rational way to deal with this situation. thanks in advance

 

[Gauss]

It depends on your clinical decision, if you think he should go back to work state to them as such and the phone calls will stop. Whatever the PCP does is their own decision. If you know this PCP perhaps just call them up and discuss what's going on.

 

[specepic]

so I recently saw a 30 something LBP pain, patient was not referred to me, came on his own, pain started 3 weeks ago, has not been to work for the last 3 weeks, taken off work by pcp, the day he presented to me, he was supposed to go back to work the next day (which was a Friday), so I wrote him a one day excuse until he could see his pcp and I explained to patient and his wife that I would write a one day excuse from work but then they need to follow up with the provider who originally took him off work, wouldn't you know it, they call the following week Monday asking for an excuse from work and then the next day Tuesday asking for more time off from work, how do I deal with this situation? any input would be appreciated. I thought unless a pcp referred to you, the taking on/off work was up to the original provider who takes a patient off work, any good logical rational way to deal with this situation. thanks in advance

I dont understand the issue. Number one error here is taking self referred pts IMO. These are your trouble makers, addicts, etc. Insist on a referral from PCP and review the notes. It doesnt take long and it will save many HAs. I can list about 10 reasons why taking self-referred pts to a spine/pain practice is a bad idea but I'm sure others will chime in.

As to the issue at hand. It is fairly simple. What is your medical opinion. I am ok to do work notes when indicated. The pts who usually need them dont ask and I offer. The ones who def don't need them are the ones who usually bug you 3x/day.

I also request all PW be presented to my MA who fills in 90% of it and I sign if I feel appr. Some pts keep it in their pocket until you are wrapping up visit and on the way out the door. They get to come back later and I fill it out when I have time and my MA has prefilled.

 

[Louisville04]

As to the issue at hand. It is fairly simple. What is your medical opinion. I am ok to do work notes when indicated. The pts who usually need them dont ask and I offer. The ones who def don't need them are the ones who usually bug you 3x/day.

I also request all PW be presented to my MA who fills in 90% of it and I sign if I feel appr. Some pts keep it in their pocket until you are wrapping up visit and on the way out the door. They get to come back later and I fill it out when I have time and my MA has prefilled.

How do you decide on how many days off? I always hear the Deyo article about bed rest being bad. Most of my patients are chronic back pain, so they just need a note to miss work for the day of the appointment.

Does your MA fill out paperwork that asks how long can the patient sit, stand, how many breaks needed, etc? FCE is not available.

 

[ampaphb]

Simple answer. You felt one day was appropriate. when the patient calls back askig for more time off, the answer is no.

As for those pesky how much can the patient lift forms? I generally fill them out with words like indeterminate or uncertain.