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Sicknotes make me sick

I have a problem with sicknotes. I realise that many GPs don't, and are happy to distribute them with largesse, like confetti, but I intensely dislike issuing Med 3 forms to people who are

manifestly in very much better health than I am.

Take, for example, this young lady. She sprained her thumb last year (she fell over outside a pub) and it mysteriously failed to get any better. 'Awful pain, doctor, just there,' she would say, waggling it about happily.

After a month I told her that in all conscience I couldn't sign

her off any longer, and sent her back to work.

On arrival at the nursing home where she worked, she told the matron (or whatever) that because of her sore thumb, she couldn't guarantee she wouldn't suddenly drop a resident head-first on to

the floor as a result of the pain she was suffering.

In a fit of compensation-induced anxiety, the matron sent her home with the instruction that she shouldn't come back again until it was all sorted out.

I sent her to see a hand surgeon. Reading between the lines of his letter, it seems he didn't believe her either, but he suggested an arthroscopy of the wrist.

The waiting list for this was six months, and my patient was totally unable to suppress a gleeful grin when she told me about her extended gardening leave. I

phoned the surgeon, off the

record, and begged him to speed up the procedure.

'She's a lazy bastard!' I explained. 'I thought so,' he retorted. 'I'll try for a cancellation.'

Three weeks later she was admitted, scoped, given a clear bill of health, and sent packing. She went back to work, and immediately dropped a patient head-first on to the floor. Only a haematoma and a week of concussion, luckily for everyone.

I have another patient who is hale, happy, fit and hearty until the day the letter from the DSS arrives telling her she is fit for work.

At that moment she is struck by profoundly disabling symptoms of anxiety; tremors, anorexia, insomnia, and agoraphobia.

These symptoms last until the very instant that I issue this trembling wreck with a

sicknote, and when I hand it over I can see the terror leave her like a receding tide.

She leaves the room smiling beatifically. At which point I want to take it back and rip it up. Which would, of course, start her afflictions all over again.

Our role as GPs is being chipped away bit by bit, and most of this is deplorable.

But I must admit to a sneaking desire that maybe someone, someday, will take the

sicknote responsibility away

from me.

It is way too complicated and the conflict of interest distresses me, and more to the point, writing all those forms is giving me tenosynovitis of the wrist and

I may need some time off work to recover.

I'm sure my GP will understand.

Dr Phil Peverley is a GP in Sunderland

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