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Fit note confusion

Dr Mandy Fry learns to never judge a patient by their fit note request.

Dr Mandy Fry learns to never judge a patient by their fit note request.

Dr Mandy Fry receives a copy of Dr Phil Hammond's latest DVD, Dr Phil's Rude Health Show.

‘I'd like a fit note please.' Well there it was, my first ever specific request for a fit note (rather than a sick note). And from what an unexpected source. Call me prejudiced but I would not have expected Tracey, 24-year-old single mother of four, to be the one most up to date with the prevailing political terminology. She continued with ‘It's my New year's resolution you see doctor...' How on earth did I respond to that?

I can see that working as a sales assistant in a discount fashion retailers would hardly be chosen as anyone's idea of their dream job, but it seemed unlikely that as employers they would condone someone taking time off during the manic January sales season. And what would I write as the reason for absence?

After all Tracey was hardly ill. She was just a typical young woman who was overweight as she ate too much of the wrong things (probably because that was what she could afford), smoked too much (hence the inability to afford good food...) and went out scantily dressed at the weekend, relying on her alcohol consumption to keep her warm (when you or I would be wrapped up in coat, scarf and gloves if we ventured out at all). Her lack of extended social support meant that she consulted repeatedly for minor self-limiting illness, both for herself and her children, but she didn't have any real significant health issues. Certainly none that I could envisage necessitating time off work...

Just as the silence was stretching into that awkward phase when you know that you really are going to have to say something, even though you have no idea what, she rescued me. "It's for the gym..." I hoped that the dawning realisation was not too obvious as it spread across my face. She didn't want time off work at all! She wanted a note to get reduced gym membership so that she could try and lose some weight and get fit. Finally, someone who had actually listened to my usual pre-Christmas health promotion spiel that ‘perhaps this year is the one when you resolve to lose weight, stop smoking etc. (fill in the blanks as appropriate)'.

Unfortunately, my prior lack of comprehension clearly had been evident in my facial expression. ‘What did you think I meant, doctor?' How to respond to that?

I didn't want to put ideas into her head that having certified time off work was an option as I was sure she might embrace it with open arms - and then I would have to seriously back pedal. Again words escaped me as I struggled to know what to say. I tried resorting to silence once more but she pressed me for an answer so I decided that honesty, as usual, was the best policy. ‘I thought you wanted a note for time off work,' I muttered quietly. ‘Why on earth would I want that?' she answered – ‘the January sales are the best time for bargains, you know, and I get to seize them as soon as they come in'. And once more I had cause to reflect on my apparent inbuilt prejudice - clearly being a sales assistant in a discount fashion retailers is someone's idea of their dream job after all.

By Dr Mandy Fry

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