Confessions of a GP

Sick notes

These are some people who have asked me to sign them off work. What do you think? Would you sign them off?

• A bloke in his late twenties works in some sort of IT firm. He has had a big row with his boss and has resigned, but doesn’t want to work out his notice because the atmosphere is horrible in the office. He’s a bit stressed about it all but isn’t depressed or unwell and is out looking for new jobs and going to interviews. He wants a sick note to say he doesn’t have to go to work for the next three weeks until his notice runs out. He won’t get paid unless he gets one.

• A woman has been on annual leave this week but has been in bed with a bad cold. She would like a sick note to say that she was unwell during her holiday so that she can take an extra week of annual leave at another time.

• A 25-year-old bloke has been on jobseeker’s allowance (the dole) for one year. Three months ago, he got really pissed, climbed a tree and then fell and fractured his leg, arm and pelvis. He is recovering quite well and is out of hospital but on crutches. If I give him a backdated sick note from when he had his accident, he can claim incapacity benefit for the time since his fall, which is more than jobseeker’s allowance. Of note: he has spent most of the last three months being looked after in an NHS hospital and so has not really needed much money.

• It is early November and a woman wants to be signed off on sick leave because Christmas is coming and her mother died at this time several years ago. Her cat has cancer and she thinks that she won’t be able to cope at work until January. She doesn’t have any symptoms of clinical depression.

• A man was sacked from his job because of heavy daytime drinking and being drunk at work. He feels that he is unable to work now because of his alcohol dependence. He is not willing to be referred to an alcohol counsellor or a rehab programme.

• A 25-year-old man was born with severely deformed arms and, at the age of 18, was signed off as disabled. A year ago he got a job at a supermarket but was sacked after being caught giving his friends unauthorised discounts. Now he wants to go back on to disability living allowance. He doesn’t have any new illnesses or disabilities.

• A 45-year-old woman who is extremely overweight and gets very short of breath because of her heavy smoking and large size. She did have a job in a supermarket but because it is on top of a hill she can’t get there. She is making no effort to stop smoking or to lose weight.

What do you think of this lot? Would you sign them off? As you can see, the decisions I make on sick notes are often less related to my medical knowledge and more to do with my general sympathies towards a particular person on that particular day. When I hand out a sick note, I am basically signing that person a cheque made up of taxpayers’ money.

Am I any more qualified to make these decisions than someone with no medical training? These patients are people doctors potentially know quite well and sometimes it can be hard to say no to them. It is also very difficult to prove or disprove what they are telling us. For example, I have a patient who tells me that she can’t work because she has a panic attack every time she leaves her house. Perhaps she does. Perhaps she doesn’t. I am not going to sit outside her house and follow her into town taking photos of her having a great time in a crowded shopping centre. Physical symptoms are equally difficult to disprove. If a patient tells me that he has back pain, who am I to disbelieve him. He may have multiple normal scans, X-rays and examinations, but if he tells me that his back hurts and he can’t work, do I have the right to call him a liar? We are taught to listen to our patients and try to do our best for them. It is very difficult all of a sudden to start distrusting them and try to catch them out.

Although I do have patients trying to pull the wool over my eyes, most of my patients who are requesting a sick note or claiming disability payments are doing so genuinely. They have an illness or disability and need some medical documentation to verify this so that they can get some money to live on. Most people do actually want to return to work as soon as possible. Whatever our job, we generally moan about it and look forward to having some time off for a few weeks a year, but ultimately most of us want to be employed. It is partly how we define ourselves and there is a social stigma attached to not working. From a personal perspective, my job is rewarding and I feel valued. If I take time off, then I feel I am letting down my colleagues and patients. I do sometimes wonder whether my work ethic would be so strong if I had a less appealing job. If I toiled stacking shelves overnight in a supermarket for the minimum wage, I can imagine that the temptation for ‘pulling a sickie’ would be pretty strong. Perhaps I could even hoodwink my GP into writing me off work completely. I could then get close to the same pittance sitting at home on disability payments.

Most GPs hate giving out sick notes and filling in disability claim forms. They take up time and valuable appointment slots. I heard of one GP in a particularly deprived part of Wales who completely gave up trying to assess his patients’ ability to work. He used to go into his crowded waiting room each morning and ask everyone who was in for a sick note to put up their hand. Without asking any of them a single question, he would then go round and dish out a sick note to each one of them and therefore clear half of his waiting room. This allowed him to spend his morning as a doctor rather than as a clerk for the Benefits Agency.

There are many millions of people on benefits and they are costing the country billions of pounds. As a GP, I have a social responsibility to try to encourage people to work. This is partly for the good of the national economy and also because working is good for you. Evidence shows that working is beneficial to our physical health and mental wellbeing. I wish I could convey this to some of my patients on long-term sick leave. Some of my ‘disabled’ depressed patients are only in their early twenties and I know that they’ll probably never ever work. It is very sad and I don’t want to sound unsympathetic, but moping around at home watching daytime TV surely can’t be helping. When I have the energy, I do try to urge my patients to think about the positives of having a job and encourage them to get back to work. Sometimes, no matter how hard I try, they end up leaving with a sick note.