“What can I do for you today?” I asked a patient scheduled to see me about her migraines.

“I’m all better, now, I just need a work note,” she said. “My boss said I had to bring one because I was out the past two days.”

“So, you had to take time off of work today to come to get a note that said you’re better?” I asked.

“Yep,” she said, “and then I have to go back to work and make up the hour I took off to get it.”

Why do adults need doctor’s notes for their bosses at all?

doctor notes history of treatment patient and consulting
A doctor’s note proves nothing — and it’s often expensive to procure. Getty Images/iStockphoto

When I was in high school, I needed to bring in a signed excuse from my parents if I was out sick. That made sense, I was underage. But it didn’t have to come from a doctor.

So why do bosses require adult employees to bring work notes from their doctor if they are out sick for few days? Does it really deter people from calling in sick, or does it result in more time lost from work, unnecessary expense and possibly even an overuse of antibiotics?

Not to mention some people just avoid their workplace doctor’s note policy by staying on the job and spreading their germs!

This patient could have called, and we would have provided her a note that indicated she was better, but she was told that she couldn’t go back to work without it, and wanted immediate service. So, she left her work and came to my office, hoping for a same-day appointment to get her work slip to return to her job right away.

Does it really deter people from calling in sick, or does it result in more time lost from work, unnecessary expense and possibly even an overuse of antibiotics?

Luckily, we could accommodate her, but not all doctors have access like that, and many are fully booked for weeks in advance. That situation would leave patients with no alternative but to go somewhere else if they really needed that note.

In many cases, it’s an urgent care center. People can walk in, wait their turn, and then get whatever documentation they need for returning to work. But that’s another copay for them, a charge to their insurance, and all they needed was someone saying they were sick when they were absent, but now are not, and cleared to return to their job.

People who don’t have access to a doctor or urgent care might have to go to the emergency room, only for the purpose of getting a note. Average visit charges in the ER can run into the hundreds, even thousands of dollars. This is definitely not a cost-effective way to get a work note. Insurance may not even cover the charge if there was no true emergency.

Unnecessary care can be delivered as well. Some folks who come in early when they are sick, just to get that note, admit they might have otherwise just stayed home to recover. But when they do show up, they figure that they took the time to come, and often want medication for their symptoms.

I can’t count how many times I have heard this: “Well, I wouldn’t have come but I needed that note, and since I’m here, maybe I can get some antibiotics to make this cold go away sooner?”

For some people, taking time off and losing pay is not an option, so they stay at work while sick. This becomes a vicious cycle, with colds and flus traveling from one person to the next, eventually exposing everyone in the office — and their families at home.

I asked my patient what her boss did with the notes. “Puts them in a file, I guess,” she said. A file no one will ever see, filled with unnecessary notes written for illnesses that have passed, just to prove that people who were sick did what they should.

The time has come to stop demanding notes from the 98 percent of people who use their sick leave appropriately.

Just saying you are sick should be enough. I shouldn’t have to prove it with a note.

After all, if someone wanted to misuse the system, they could tell me they were out for being sick, and had already recovered. I’d still write my note, and they would present it to their boss and no one would be the wiser.

So, the best, most cost-effective way to handle sick leave is to suggest that sick people stay home and come back to work when they are better. If they are under the limit of their allocated sick time, no note required!

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