Patient requests a doctors note for work...

[n2b8me]

I don't know about y'all, but patient's are always asking for doctors notes for work. Crazy right?!?
What's your take on this?
"sure take the rest of the year off. Here's your note!"
"no way! you don't have to miss work for this."
"3 days, everybody gets 3 days off here"
or is there evidence based decision support for this based on their injury, job description, shift length, comorbidities... yada yada?

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[RustedFox]

At my one shop, it was common for "family members" to show up in "support of the patient" and ask for a work note.
All 3-6 of them.

Patient gets a note only.

 

[JacobMcCandles]

Depends on the issue. If it’s an acute issue, I’ll give a few days. If it’s a chronic issue then I recommend they get one from their PCP. If someone says I need a doctor’s note or else I’ll be fired, I immediately think there are probably 50 other reasons they’re about to be fired.

 

[Janders]

Most of these people work for ****ty companies that will drop them for no reason. They get a note.

Many of these people have fevers and contagious disease. They get a note.

Pretty much everyone gets a note for a couple days unless you are just an insane malingerer.

 

[bravotwozero]

At my one shop, it was common for "family members" to show up in "support of the patient" and ask for a work note.
All 3-6 of them.

Patient gets a note only.

This isn’t worth the fight for me. I’ll give anybody a note for any amount of days off, no skin off my back. Especially since I can tell the RN to give the patient/whoever one. One thing I could care less about.

 

[emergentmd]

I am not their boss, not their conscience, and gatekeeper for businesses.

Everyone who leaves my ER automatically gets a note for 2 dys off. This saves alot of time going back to write notes. If you want up to a week, no questions asked. If you want more than a week, then you need to give a good reason. Almost never do they ask for more than 3-4 dys.

 

[Tenk]

I tell the RN to write one for whatever they feel like because I don’t care. Some just write they were seen, some several days off. 🤷‍♂️

 

[Mbekweni]

This isn’t worth the fight for me. I’ll give anybody a note for any amount of days off, no skin off my back. Especially since I can tell the RN to give the patient/whoever one. One thing I could care less about.

I tell my nurses to take care of it. Anybody can get up to 3 days off. More than that and I want to hear about it.

 

[cyanide12345678]

Anyone want to buy the domain doctorsworknote.com from me? I’m too lazy to build a website on it 😂😂😂

Edit: I’m not joking 😂

 

[Apollyon]

I mean, ipso facto, if they ask for a work note, that means they have a job, and are working. So, whatever I can do to help them out, I did it.

 

[cyanide12345678]

Any takers 😂😂😂????

 

[WorkNoteEmergency]

My handle says it all. I am only stingy with work notes if the patient is a jerk. If you’re a nice patient (and most of mine are) I am nice back. That being said, it’s rare for me to give more than 3 days off. When I was a Navy doc, I was very stingy with the SIQ (Sick in Quarters) notes. I told the sailors they meant bed rest and their Chief would be able to find something for them to do.

 

[CoolDoc1729]

My favorite work note ever.

Able bodied 20 something year old in a minor mva. Rads negative. I ask her if she needs a note for work.

“No.. I don’t work.. but can you give me a note for my roommates so they don’t ask me to do anything hard?

🤔
Sure !

“Firstname lastname is not capable of doing anything hard “

Cooldoc1729

 

[WilcoWorld]

My only concern here is malpractice exposure - like if you're too sick to work for 2 weeks then you should be seen in follow up.

So I'll usually write something like "Benny Soreback was seen in our Emergency Department on Sunday. Please excuse him from work on Monday and Tuesday. If he's still unable to work on Wednesday he needs to be reevaluated by his primary care doctor."

 

[VA Hopeful Dr]

I'm not EM but my approach when patients ask is "talk to the front desk for however many days you want, but heads up I don't fill out FMLA paperwork".

The front desk knows that as long as the request is not ridiculous that I'm okay with it. Like the patient last month that wanted a month off of work when they had the flu...

 

[RustedFox]

This isn’t worth the fight for me. I’ll give anybody a note for any amount of days off, no skin off my back. Especially since I can tell the RN to give the patient/whoever one. One thing I could care less about.

I have mixed feelings about this.

 

[BoardingDoc]

Most people get the next day or two off if they simply ask for a note. People who have something more significant going on (or are clearly going to be a typhoid mary at work) I'll occasionally give a full week if it seems reasonable. No one gets anything longer than that. All requests for any kind of paperwork is declined (workers comp etc) and they get a referral to occupational health if needed.

 

[Saddleshoes]

I spent time working in a state institution where everyone was tring to game the system. As a result, I learned to only right notes to cover the time the patient was directly under my care.

"Mr. Patient was in my shop from 10:30 AM to 11:30 AM today (04 June 2023)."

 

[miacomet]

Some ERs just leave these in the waiting room so patients can fill it out themselves.

I tend to be fairly generous- after all, I'm not the expert on what their job entails. Sometimes workers comp cases want to go to work so they can get paid, and I feel I'm an expert at writing a note that makes it so their restrictions allows this, and they won't actually have to do any work.

I'm not carrying water for the capitalist class.

 

[miacomet]

I am not their boss, not their conscience, and gatekeeper for businesses.

Everyone who leaves my ER automatically gets a note for 2 dys off. This saves alot of time going back to write notes. If you want up to a week, no questions asked. If you want more than a week, then you need to give a good reason. Almost never do they ask for more than 3-4 dys.

Fantastic. I do the same except for the WC cases where they want to go back to work. I love writing "no sitting, no standing, no walking" and letting the boss figure it out.

 

[FlaminHotER]

I use to fight this

“You have a stubbed toe, you can go back to work right now.”

But it just led to fights not worth it

Now I’ll give a work note for a 3rd cousin if it gets them out of my ER immediately

 

[JacobMcCandles]

I use to fight this

“You have a stubbed toe, you can go back to work right now.”

But it just led to fights not worth it

Now I’ll give a work note for a 3rd cousin if it gets them out of my ER immediately

Either way these people are leaving the ER. If it’s a chronic issue then I’d prefer not to continue to reward bad behavior. It’s like unnecessary antibiotics, I can’t control what other docs do but I can control what I do.

 

[Apollyon]

Either way these people are leaving the ER. If it’s a chronic issue then I’d prefer not to continue to reward bad behavior. It’s like unnecessary antibiotics, I can’t control what other docs do but I can control what I do.

If people fight back against this, you are morally injuring yourself. As I said, if they need a work note, that means they are working. This is an avoidable error.

 

[RustedFox]

If it merits a work note, I give them a work note.
No, your five "family members" do not get a work note - I did not render them treatment or care.

Then, there's the part of me that says: "Wait a minute, corpo jackasses DGAF about anyone anymore, so THEY need to learn a lesson."

 

[Brigade4Radiant]

I don’t mind giving some people 3 to 4 days off. The ER bill is expensive. If there a stress enough to go to the ER, maybe they should just have a few days off to get their stuff together.

They can use some of their sick days. They are at least paying 250 for the visit. since they are concerned about the work note they have a job.

If you got into a car wreck and you have no injuries, I will give you a good amount of time if that’s what you need.

I would prefer this to people wanting tests or wanting opioids

 

[Janders]

Let me add this; in people that have mild/moderate illness and patiently waited 1-3hr to see me… often at midnight, because the worked second shift and couldn’t get a ride… and are completely happy with my spiel about how its viral, they don’t need antibiotics, but maybe some Motrin would help the aches etc…. I often end the conversation with “do you want a note for work for a couple days?”

I’ll give you the most common answers—>
(1) Um, I’ll take one for today, thanks!
(2) Nah I need to work.
(3) I guess today and could I get tomorrow? I have a fever and I have to be in there at 0600 and its 0300 right now…
(4) Nah, I’m self employed / do uber-door-dash, I can just take some time off.

I’ll have people with a fever of 103 with the flu who I have to INSIST on giving a work note.

Yes some incredible people request 2 weeks off, but they are few and far between. I seriously insist on contagious people taking 1-2 days off their very crowd-facing jobs way more often than people ask me for silly notes.

This isn’t to mention all the people with significant ortho injuries (frx, dislocation) who do very hard jobs, and likely can’t perform at all x weeks.

 

[Janders]

There was a guy I saw recently with an INCREDIBLY minor injury (think skinned knee that barely needed a bandaid) who’s boss insisted he leave, insisted he couldn’t be seen at UC or PCP or occ health, and INSISTED he wouldn’t be allowed to work until he brought a note from the ER. This was in writing, with the patient. Patient was very young, and super apologetic for wasting my time.

I told him maybe it was a good idea that I wrote him for a 3 day weekend since his boss was SO worried about him. The absolute delight in his eyes when he realized my insinuation… he then asked “my boss can’t see my chart, can he? Like see you did no tests and I’m totally fine??”…. No sir, that’s your protected medical information, he surely can’t see that!

 

[FlaminHotER]

Either way these people are leaving the ER. If it’s a chronic issue then I’d prefer not to continue to reward bad behavior. It’s like unnecessary antibiotics, I can’t control what other docs do but I can control what I do.

When it comes to meds or unnecessary abxs yeah I absolutely agree. No way

 

[GonnaBeADoc2222]

idc, I write the note. Usually for 1 to 3 days. I don't write for a week.

Whoever said they reflexively print a note at every discharge is a genius. I am going to start doing that simply to avoid the subsequent nurse conversation.

 

[GonnaBeADoc2222]

I love the workers comp / FMLA paperwork requests.

Me: "Sorry, I don't fill those out. You'll have to see your PCP or occ health."

Nurse: "Patient says they're not leaving until you fill this out."

Me: "Sounds good" [walks away to get coffee]

 

[BoardingDoc]

I love the workers comp / FMLA paperwork requests.

Me: "Sorry, I don't fill those out. You'll have to see your PCP or occ health."

Nurse: "Patient says they're not leaving until you fill this out."

Me: "Sounds good" [walks away to get coffee]

I usually need the room so I just have security escort them out if they refuse to leave.

 

[DocEspana]

Our greeters are nice enough to tell people up front to not even register if its WC or FMLA because we just *dont*.

I generally just hand any patient (that hasn't earned my personal ire, of which some do) a blank work note signed by me and tell them to fill it in with any amount of days they think they can justify to their boss. My nurses have realized I simply DNGAF about this, and have stepped in and just write 2-3 days automatically and don't even ask me any more because they know I'll just give a get out of work forever note.

It actually worked perfectly because I'm the only person they dont harass 10-15 times per day for work notes, because they know I will give them.

 

[RustedFox]

I had one patient at 3am todau report that she sleepwalks, and that while sleepwalking she must have taken 20+ Xanax and 8-10 fluoxetine. Oh, and that she fell and struck her head and was found by her "partner" on the ground with blood all over (yet no lacerations anywhere).

Upon entering the room to discuss results (patient has been texting the entire time), she asks if she can have a 3 day work note before she goes home. Radically, I recommended admission and observation due to that large number of BZDs that she "had taken".

She said: "No, I'm okay LOLZ, and I want a 3 day work note."

Discharged AMA with no note.

Piece of trash.

 

[CoolDoc1729]

I usually need the room so I just have security escort them out if they refuse to leave.

These types don’t get a room at my place anymore. You have to be a tele admit , actively suicidal or an obvious ICU. Sit in the waiting room the rest of your life if it makes you happy lol

 

[gruemd]

I will literally tell people, "if you want a work note, I don't care, it's your paycheck, not mine" (in a nice/jokey tone, that sounds like I'm an a** through text). I very rarely give more than 2-3 days, blame it on the mysterious "oh yeah we can't do that, that should be done through your primary doc if you need more than that." Same as the mysterious "they" that won't let me give acute injuries more than a very few days of pain meds.

Also, I do fill out WC paperwork sometimes, but it's probably a bit different at my shop, but WC/OH is basically an in-house entity, so the paperwork basically doubles as the work note until they follow up with OH.

 

[wholeheartedly]

I’m confused about the WC thing. I get not doing FMLA paperwork. But at my former hospital, if an employee fell on the ice in the parking lot and got hurt pretty good (we had some broken bones), they’d get sent to the ED and the docs filled out the initial injury eval form. After that, subsequent forms need to be done by primary etc. We also had stuff come in like a guy got electrocuted at his oilfield job, some folks w/chemical burns, work related crush injuries, etc.

What kinds of workers comp forms are people expecting you to fill out?


@VA Hopeful Dr no FMLA forms ever? even long term established pts with legit need?

 

[VA Hopeful Dr]

I’m confused about the WC thing. I get not doing FMLA paperwork. But at my former hospital, if an employee fell on the ice in the parking lot and got hurt pretty good (we had some broken bones), they’d get sent to the ED and the docs filled out the initial injury eval form. After that, subsequent forms need to be done by primary etc. We also had stuff come in like a guy got electrocuted at his oilfield job, some folks w/chemical burns, work related crush injuries, etc.

What kinds of workers comp forms are people expecting you to fill out?


@VA Hopeful Dr no FMLA forms ever? even long term established pts with legit need?

It's complicated. Keep in mind this is a thread for ED patients requesting work notes. Typically this is going to be mildly sick people (sinus infections, bronchitis, cellulitis and so on) or minor injuries (sprains, strains, and so on). They don't need FMLA 99.9% of the time. If it's severe enough that they do, usually they end up admitted (pneumonia, COPD, appendicitis) or with a specialist referral (broken bones).

There's a separate thread in the FM forum that deals with patients seen outside of a single acute visit.

 

[GonnaBeADoc2222]

I’m confused about the WC thing. I get not doing FMLA paperwork. But at my former hospital, if an employee fell on the ice in the parking lot and got hurt pretty good (we had some broken bones), they’d get sent to the ED and the docs filled out the initial injury eval form. After that, subsequent forms need to be done by primary etc. We also had stuff come in like a guy got electrocuted at his oilfield job, some folks w/chemical burns, work related crush injuries, etc.

What kinds of workers comp forms are people expecting you to fill out?


@VA Hopeful Dr no FMLA forms ever? even long term established pts with legit need?

I don't see why ED docs would be involved w these forms. Employee can send our ER documentation to employer.

We shouldn't be in the business of evaluating injuries as they pertain to work limitations etc, and if we are, we should be compensated extra for it.

 

[BoardingDoc]

I don't see why ED docs would be involved w these forms. Employee can send our ER documentation to employer.

We shouldn't be in the business of evaluating injuries as they pertain to work limitations etc, and if we are, we should be compensated extra for it.

Agreed. I don't know anyone that does WC forms of any kind in the ER. They can go to occ health and occ health can request the ED chart as needed.

 

[Groove]

If writing work notes or workers comp forms is the worst part of your job....then I want your job!

I literally could care less about work notes. I write them for almost everyone and if a family member or friend wants one, sure...why not. I've never been asked to do any sort of FMLA stuff.

In fact, the only thing annoying about work notes is when I've discharged a pt and the nurse can't discharge them because they want a work note and she walks in another pt room while I'm getting history to ask whether I will write them a work note. So, I just write them for everyone.

I get perverse satisfaction filling out the WC forms because I write in "cursive doctor font" and everything is completely and utterly illegible.

 

[RustedFox]

Okay @Groove.

You know I love you, man.

The one thing that drives me nuts is illegible "cursive doctor font".
I have said to other physicians: if you can't master handwriting, then repeat 2nd grade.

True story:

/b/

be me.
3rd year med student.
Gen.surg rotation.
Everyone says that the surgeons are walking poison, just looking for the next med student to abuse because they're on their little powertrip.
Pre-rounding at 5am? Lol.
I say "anything that can be done at 5am can ALSO be done at 7am, when people are awake and functional".
D*ckhead gen.surgeon overhears this and spouts off at me, marks me for execution.
Try reading the notes. This was back when there were paper charts, kids.
D*ckhead tries pimping me on pre-op labs, or post-op labs, or whatever, idc.

"WHAT IS THE PATIENT'S WHITE COUNT?"
"I don't know"
"WHAT POST-OP DAY IS IT?"
"I dont' know"
"YOU DON'T KNOW ANYTHING ABOUT YOUR PATIENTS??! DID YOU READ THE CHART?!?!"
"Yes."
"WELL WHY DON'T YOU KNOW ANYTHING THEN?!?!"
"I don't read arabic."
"I DIDN'T WRITE THE CHART IN ARABIC !!!!!"
"You didn't?"

/mfw I'm in somebody's office, explaining calmly what happened. I honestly thought it was arabic.

D*ckhead writes a scathing letter about me to the dean, gives it to his secretary, and asks her to mail it to my school's dean.

/mfw his secretary calls me in the office, explains the instructions she was given, and then puts the letter thru the shredder in front of me.

She says: "You're the only one to stand up to his abuse. I'm not punishing you for doing the right thing."

 

[Groove]

Okay @Groove.

You know I love you, man.

The one thing that drives me nuts is illegible "cursive doctor font".
I have said to other physicians: if you can't master handwriting, then repeat 2nd grade.

True story:

/b/

be me.
3rd year med student.
Gen.surg rotation.
Everyone says that the surgeons are walking poison, just looking for the next med student to abuse because they're on their little powertrip.
Pre-rounding at 5am? Lol.
I say "anything that can be done at 5am can ALSO be done at 7am, when people are awake and functional".
D*ckhead gen.surgeon overhears this and spouts off at me, marks me for execution.
Try reading the notes. This was back when there were paper charts, kids.
D*ckhead tries pimping me on pre-op labs, or post-op labs, or whatever, idc.

"WHAT IS THE PATIENT'S WHITE COUNT?"
"I don't know"
"WHAT POST-OP DAY IS IT?"
"I dont' know"
"YOU DON'T KNOW ANYTHING ABOUT YOUR PATIENTS??! DID YOU READ THE CHART?!?!"
"Yes."
"WELL WHY DON'T YOU KNOW ANYTHING THEN?!?!"
"I don't read arabic."
"I DIDN'T WRITE THE CHART IN ARABIC !!!!!"
"You didn't?"

/mfw I'm in somebody's office, explaining calmly what happened. I honestly thought it was arabic.

D*ckhead writes a scathing letter about me to the dean, gives it to his secretary, and asks her to mail it to my school's dean.

/mfw his secretary calls me in the office, explains the instructions she was given, and then puts the letter thru the shredder in front of me.

She says: "You're the only one to stand up to his abuse. I'm not punishing you for doing the right thing."

That's hilarious man. That's some cajones for a surgey rotation. It reminds me of this med student I had on rotations who lacerated his wrist in a freak accident leading up to med school and had this chronic muscle wasting and permanent tremor with chronic pain syndrome affecting his hand and wrist. Well, he was on scheduled narcotics and would be popping these things all day long. He was a talkative, charismatic guy at baseline but when he took his meds....he developed this zero filter and some of the stuff that would come out of his mouth during rounds and in front of attendings and even patients was straight up hilarious. I've never had such a hard time keeping a straight face. I wonder whatever happened to that dude. Anyway, not that you were popping narcs during med school but that story reminded me of that guy, lol.

But yeah...my doctor font handwriting sucks. My Rx signature looks like a bird foot rubber stamp.

 

[RustedFox]

That's hilarious man. That's some cajones for a surgey rotation. It reminds me of this med student I had on rotations who lacerated his wrist in a freak accident leading up to med school and had this chronic muscle wasting and permanent tremor with chronic pain syndrome affecting his hand and wrist. Well, he was on scheduled narcotics and would be popping these things all day long. He was a talkative, charismatic guy at baseline but when he took his meds....he developed this zero filter and some of the stuff that would come out of his mouth during rounds and in front of attendings and even patients was straight up hilarious. I've never had such a hard time keeping a straight face. I wonder whatever happened to that dude. Anyway, not that you were popping narcs during med school but that story reminded me of that guy, lol.

But yeah...my doctor font handwriting sucks. My Rx signature looks like a bird foot rubber stamp.

Chickenfoot!
Man, I love Sammy Hagar.