Re: FCPS request for doctor's notes
Date: February 29, 2016 08:14PM
The tyranny of doctor’s notes
Russell Saunders / April 3, 2012
This post is both an observation and a related query. I want to know if what I’m seeing is particular to my area, or if it’s happening all over the place.
As one might imagine, I see patients for all manner of medical complaint. Some of them are complicated and severe, and some are minor and self-limiting. Because common things are common (a medical truism, of which we are reminded in our training when we go off investigating bizarre and rare diagnoses), I see many more patients for the latter kind of problem than the former. Strictly speaking, a lot of people come in to see me for things that probably could have been monitored at home without medical attention. Mind you, I am not complaining about that fact, as these sorts of “bread and butter” visits are what keep a medical office’s doors open.
A large factor in parents’ decisions to bring their kids in for a visit is their own caution or anxiety. Educating parents about major vs. minor symptoms, what can be treated at home vs. what needs to be seen, etc is an important part of my job, as is allaying anxiety to whatever extent possible. Taking care of parents is as much (or more) a part of my job as taking care of the kids, which I think almost any honest pediatrician would say. If I didn’t like dealing with worried parents, I shouldn’t have entered the field.
That said, I have had a truly stupefying number of appointments that the parents themselves view as totally unnecessary. They don’t think their kid needs to be seen, and they know I don’t think so either. They’re missing work they don’t think they need to miss, and are languishing in my office for reasons they consider ridiculous.
Why are they there? Because their kid’s school demands a doctor’s note. Any absence attributed to illness must be verified by me, with a note documenting same. Otherwise it is unexcused, for which the student is penalized. It matters not if the illness is as minor as a cold, or if the student has an otherwise spotless attendance record. It makes no difference if the child was sent home by the school nurse (in which case a note stipulating that the child is well enough to return is required) or kept home at the parent’s discretion. Every absence requires a note, which requires a visit.
This is, of course, totally idiotic. I am providing a service when I see ill children, even if the illness is mild and the service is really for the worried parents. Those visits have value, even if they’re not “necessary.” A visit for the sole purpose of verifying the parent’s claim of sickness is a complete policy fail. It robs parents of their authority and subjugates them to the dictates of the educational bureaucracy. It contributes needlessly to medical costs and wastes everyone’s time. (Were I in cahoots with the local school nurses, I could not design a better kick-back scheme if I tried.)
When did this happen? I seem to recall that my mother’s say-so was enough to keep me home from school for a few days. I think a doctor’s note was required for lengthier absences, but for a day or so all that was necessary was for her to tell the school I was sick. When did this change?
An addition wrinkle to my observation is that it is not consistent with all parents/patients. My office is situated in an area with great socioeconomic diversity. Many of my patients attend the local exclusive and famous (you’ve heard of it) private school or the affluent public school nearby. Many of my other patients live in the much poorer surrounding areas, and attend the much less well-off schools. Whenever I offer a note to the wealthier parents, they wave it away. Apparently their word is still good. It is students who attend the less cushy schools who need the notes from me, and it is their parents whose authority has been usurped. If my observation is a true reflection of reality, then it reflects something disgraceful.
So, here comes the query — is this true where you live? If you have kids, can you keep them out of school for a day or two due to illness without needing to schlep them to the doctor? Or must you also procure a perfectly useless note from a medical provider? If so, how do you feel about this policy?
April 3, 2012 in healthcare policy.