filling out short term disability/return to work form for patients

[Dalemane]

How do you guys determine estimated return date?

should we error on the side of the patient and give more time than you think they might need?

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[rjs2131]

Have only done this a handful of times, but generally err on giving the patient more time if it's appropriate and would likely help their overall transition back to work. Tends to be fairly individual dependent, but I try to avoid sending someone back sooner than they're comfortable with (especially if there's a current risk of unmanaged/uncontrolled symptoms negatively impacting work ability/outcomes).

 

[whopper]

This issue is difficult at best in most cases because we can start a med and then not even know if the med will work.
Meds working are only highly predictable if the patient already had success with the medication for pretty much the same thing but for whatever reason is not on it now, or is on a small dose and got partial improvement suggesting a higher dosage will work much better.

I would sometimes write something to the effect of..."The return date is difficult to determine because the patient was just started on an antidepressant and these medications only cause improvement in about 50% of patients, and in those where improvement did significantly occur the improvement may only be partial and not enough for the patient to return to work."

 

[nrmp]

Are you legally bound to fill short term disability papers if requested by the patient or you can simply deny? I have seen some practices just don't do it.

 

[Mass Effect]

Are you legally bound to fill short term disability papers if requested by the patient or you can simply deny? I have seen some practices just don't do it.

In my opinion, if you're the patient's psychiatrist, you should deny. All of these requests should be up to an independent third party. Otherwise, you risk jeopardizing your relationship with your patient if you don't think he/she is disabled or even if you do, if he/she then requests extending disability or making it permanent. A blanket rule of "I don't do these, but am happy to refer you to someone" is most appropriate.

 

[Armadillos]

In my opinion, if you're the patient's psychiatrist, you should deny. All of these requests should be up to an independent third party. Otherwise, you risk jeopardizing your relationship with your patient if you don't think he/she is disabled or even if you do, if he/she then requests extending disability or making it permanent. A blanket rule of "I don't do these, but am happy to refer you to someone" is most appropriate.

I completely agree with you from one standpoint in a perfect world with no economic disparity, but I think you also have to know your patient population to decide if a blanket policy like that is really in the best interest of patients or just to shield yourself from extra work/tough decisions.

It would be cruel for me to have not signed off on the short term disability paperwork for my psychotically depressed patient making minimum wage last week. There isn’t anyone else this person could have reasonably expected to fill this out and many corporations have essentially replaced sick leave with short term disability. For example, my wife was only allowed to use one week of sick time after giving birth (despite having months accumulated) and had to use short term disability for the rest. Thankfully OBGYNs don’t get on a high horse about this so we just paid their $10 paperwork fee and had it done the next day.

Addendum: Also many of the short term disability forms I’ve seen are specifically labeled for the “treating physician” and they the company refers to their own independent examiner if they feel the decision is not obvious based on treating physician statement/records.

 

[FlowRate]

This issue is difficult at best in most cases because we can start a med and then not even know if the med will work.
Meds working are only highly predictable if the patient already had success with the medication for pretty much the same thing but for whatever reason is not on it now, or is on a small dose and got partial improvement suggesting a higher dosage will work much better.

I would sometimes write something to the effect of..."The return date is difficult to determine because the patient was just started on an antidepressant and these medications only cause improvement in about 50% of patients, and in those where improvement did significantly occur the improvement may only be partial and not enough for the patient to return to work."

IMO this is way more information than their employer should be entitled to and furthermore typically the employer usually needs a firm date for whatever HR/regulatory reasons. I just talk about a reasonable best guess date with the patient--you can always approve return to work early or extend the time off work period later.

 

[PsyDr]

How do you guys determine estimated return date?

should we error on the side of the patient and give more time than you think they might need?

By following the procedure outlined the procedure outlined in the AMA's Evaluation of Work Ability and Return to Work


Thank god no rational person would engage in a practice area without knowing the textbook in the area in which they practice.

 

[clausewitz2]

By following the procedure outlined the procedure outlined in the AMA's Evaluation of Work Ability and Return to Work


Thank god no rational person would engage in a practice area without knowing the textbook in the area in which they practice.

We'll all get right on that right after we figure out the diagnosis code we are definitely required to put down when we prescribe 0.5 mg Xanax for someone having an MRI while medically hospitalized.

 

[PsyDr]

We'll all get right on that right after we figure out the diagnosis code we are definitely required to put down when we prescribe 0.5 mg Xanax for someone having an MRI while medically hospitalized.

Interesting that being asked for a diagnosis caused such lasting anger.

 

[clausewitz2]

Interesting that being asked for a diagnosis caused such lasting anger.

Try baffled amazement at the complete inability/refusal to admit the limits of knowledge or experience.

Failing that, lack of understanding of pragmatics of communication to recognize when clarification of a misunderstanding is necessary.

 

[NickNaylor]

I will occasionally fill out this paperwork for our patients that are receiving ECT. I will typically use a 2-3 month return-to-work date in these cases to allow for time for the treatment series as well as some post-treatment recovery time, since cognitive deficits can persist for a few weeks after treatment.

Beyond that, I do not fill out this paperwork, but I work largely in an inpatient setting. If patients ask, I tell them that that is something done more appropriately by their outpatient psychiatrist... not only because they know them better, but often the insurance companies will want updates, more extended records, etc. that are more appropriately done by the outpatient psychiatrist than an inpatient doc. You are not legally compelled to complete this paperwork, though obviously patients may get upset if you choose not to do so.

 

[Dalemane]

what about something more frivolous like needing extra time on school work or getting out of jury duty? I can't think of a diagnosis that will preclude someone from serving as a juror

 

[erg923]

what about something more frivolous like needing extra time on school work or getting out of jury duty? I can't think of a diagnosis that will preclude someone from serving as a juror

Tell them to "sac up."
The question of "academic accommodations" (extended test-taking time) is a whole other deal and not within purview of a typical psychiatric evaluation.

 

[WisNeuro]

Tell them to "sac up."
The question of "academic accommodations" (extended test-taking time) is a whole other deal and not within purview of a typical psychiatric evaluation.

To add to this, back when I was teaching college coursework, we needed a formal evaluation to give these kinds of accommodations, general Drs note did not do.

 

[whopper]

In my opinion, if you're the patient's psychiatrist, you should deny. All of these requests should be up to an independent third party. Otherwise, you risk jeopardizing your relationship with your patient if you don't think he/she is disabled or even if you do, if he/she then requests extending disability or making it permanent. A blanket rule of "I don't do these, but am happy to refer you to someone" is most appropriate.

In some forms the treating doctor is supposed to make the call. The other parties involved such as the courts or the insurance companies are supposed to take into account that the provider already has a treatment bias for the patient. E.g. Medicare/Medicaid expects the provider to fill out these forms and they're well aware of the treatment bias.

When I do disability for my own patients, just in case I declare there's a treatment bias, and the party in question may want a non-treating evaluator and that I cannot serve in that role if they want it.

But it is not the standard to deny all the time. Like the Medicare/Medicaid example they already know the treating provider has a bias. The patient will also realistically not be able to obtain a non-treating provider for a disability evaluation due to the high costs and insurance won't cover such evaluations because it's not for treatment.