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Independents' Day

Pulling a sickie


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I’m still feeling the remnants of a warm glow as my next patient enters, but it’s fading and about to be unceremoniously extinguished. This happy flush resulted from a lady I saw this morning.

Apparently, 14 years ago, I turned down her request for a sick note for workplace unhappiness and suggested, instead, a new job, which she pursued and which resulted in, I quote, ‘The best ten years of my life.’ This was the first time she’d seen me since and she wanted to say a genuine and warm thanks. Wow. The smallest things etc.

Anyway, with blogworthy symmetry, this next customer is also unhappy at work. He explains this to me, without pause, for significantly more than his statutory ten minutes, by which time I decide the ‘open’ part of the consultation has outstayed its welcome and it’s time to cut to the chase.

‘So I understand that you’re stressed at work and feel you’re being bullied?’ Yes, he says. I explain that I am, of course, sorry to hear that, but wonder just how I can help, exactly, as if I don’t know.

He attempts to trump this by suggesting that my attitude is just adding to his stress

Ah yes, quelle surprise. He wants me to sign him off for a couple of weeks. I gently and politely explain that this is not appropriate, and, despite my CSA-approved attempts to soften the blow, he looks at me as though I’ve just taken a dump on the carpet.

So I decide to elaborate. ‘While I accept that work related stress is a thing,’ I say, ‘It’s not a medical thing, it’s a work thing, and it’s certainly not a medical or work thing that will be sorted out by being signed off sick, because that just avoids, rather than solves, the issue. This is a problem for your employer, not me.’

Now, I believe that to be impeccable logic. But he attempts to trump this by suggesting that my attitude is just adding to his stress, thereby making him worse and therefore even less capable of work.

‘So let me get this straight,’ I say. ‘You now want a sick note for stress because my refusal to give you a sick note for stress is making you so much more stressed that your stress has now reached a level that justifies the sick note for stress that I wouldn’t just a moment ago give you?’

He thinks about this for a moment. Then he storms off, only to storm back in to say, ‘You’re the worst doctor ever,’ before storming out again.

I doubt this is a life transformed, but I am certain of a complaint and a one-star NHS Choices rant. It’s not all bad, though. I seem to be glowing again.

Dr Tony Copperfield is a jobbing GP in Essex


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Readers' comments (16)

  • Just give the damn thing! Not worth the fight and it’s only if we sign EVERYBODY off that they will take this”privilege” away from us.

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  • brave attitude! I wish i was always that firm, as it pisses me off too.
    I have started adding to the free text 'stress at work- I've encouraged him/her to seek a new employment'. their face when they read that is delicious......

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  • Sick note not worth the paper they are written on,dont stress give em.Dont think this is done in any other country by GPs.

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  • Let common sense prevail

    Give the sick note. This may encourage the employer to do something about the underlying issue.

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  • Agree with LetCommonSensePrevail

    I generally give these notes as a way of motivating the employer to address the situation.

    I didn't even realise it was a contentious issue!

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  • Good job Copperfield, your compassion, keenness to cement your doctor-patient relationship and complete absence of revelling in the power you hold is an inspiration to us all.Not.

    I guess most here are familiar with the aphorism "For want of a nail, the war was lost". Imagine, Copperfields patient gets drunk to ease his stress, argues with his wife and slaps her.She ends up leaving with the kids and the ripple of suffering expands radially outwards. But hey its not Copperfields problem, he doesn't have an evidence-based guideline to predicting the future.

    There is concept which relates to being an advocate for the patients until the patient is clearly trying it on. Unless the patient cited above falls into this category I would have given the note with the proviso that after a few days of complete rest from ruminating on his woes he took concrete steps to get his issue addressed by the management, invoke union or other representation etc.

    Its articles like this which feed the patients notions that GPs are power-mad and on an ego-trip.

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  • Copperfield acted completely rationally. However I got fed up of the stress with sick notes. So I say it as it is. I write the the Patient tells me they have stress at work. Then tick maybe fit for work. Then write “ I am not able to assess please arrange anOH assessment. This is not an NHS service.” This way I act rationally and they get a slip of paper.

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  • David Banner

    Don’t you just love the patient who requests a note for the stress caused by having been found fit for work by the DWP?

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  • Drachula

    I tend to give sick notes, but then, I’ve had one myself for work stress. Yes, I did get another job. It was a really tough time.
    But I also really applaud the tough stance - there’s a lot of ppl asking for sick notes because they haven’t come to the doctor. A chap last week had been off work for 3m and wanted his sick note back dating to last time he’d bothered to see a dr. Given he also hadn’t bothered to take his meds, I declined.

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  • I have had cause to be grateful to the GPs who gave me a sick note for "stress at work" when I needed to be out of my workplace for a while. After essential time out I went back to the same job, sorted out the issue that had been underlying the stress, and the NHS got a few more good years out of me. Had I been denied that note because it "wasn't a medical issue", I'd have left medicine, possibly by suicide.

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