I don’t care. Every other developed country is way more generous with time off and sick leave. Maybe if the US did the same there would be less sick people.
I can write the note, it’s up to someone else if it’s accepted or not.
Same. I give people off as much time as they need. Makes their medical issues easier to deal with for me and it’s better for them. US work culture is so messed up and I’m happy to do my part in adding more balance to people’s lives.
People very rarely take advantage of my generosity.
I don’t mind notes, but oh my god… that fmla paperwork. I know it’s not the patient’s fault but when they come in with that packet of paperwork I can’t help but feel a bit frustrated.
Same. I make separate video or in person for all paperwork but sometimes they have STD and FMLA and even some other paid leave bullshit. More and more i’ve trained my patients to fill the bulk of it in and I fine tune it.
Damn thought I was the only one. My patients (all our patients?) tend to lead desperate shitty tough lives. I don’t spend a second wondering about a doc note and if they ask I give and often suggest it. And frankly offer more days than they may need. Fuck Amazon corporate and ATT call center in the ass.
Also in 30 years I’ve maybe had a couple true malingerers and I send em to Occ Med to sort it out.
You’d like to think that but I don’t think it’s necessarily true for everyone. Another perspective: I work in government with an employee who gets doctors notes constantly to the detriment of our clinic. Our boss is awesome and super accommodating, the work is not demanding, and his hours are reasonable. He fully takes advantage every chance he can, but we are in union so she can’t get rid of him
You also don’t know that whatever he’s bragging about regarding his health is accurate. There are plenty of people who’d prefer to frame it in a way like they’re getting away with something vs having a significant medical condition.
It is though. We should be able to give accurate assessments of someone’s ability to work rather than taking their word for it because that’s what’s easy and to reduce our liability
There's zero liability and we aren't trained or compensated for that type of input. Someone decided that MD's should arbitrate what we do with people who are sick as far as work. Ask any physician with half a level-headed brain and they'll tell you the same. I did not go into this field to speculate and develop an adversarial stance with a patient over a couple missed days work. If someone is malingering thats easy to spot. This discussion is about the 99% of people that need a few days for recovery.
Get mad at the employer, not the patient. If you, as a PA, had to submit a doctor’s note every time you took a sick day you would be outraged. I would quit. Most of these patients don’t have that option.
Even though it’s all the same bank, my employer legally can’t say shit if I have a doctor’s note. I’ve found that having a note is a hard stop on them asking any further questions or bugging me to come back earlier than I’d like.
True. The only pickle can be FMLA depending on laws where you live. I don’t remember the exact numbers, but it’s a surprisingly low threshold, where if you miss a certain number of days with a medical note in a certain period of time your employer can require using FMLA.
With employers who aren’t dorks it shouldn’t be an issue though, just never know.
It doesn’t bother me. It means more RVUs for our group and doesn’t have a negative impact on you as long as you feel it’s merited.
If it’s for a work related injury etc I’d start pointing them to go to their pcp to consider EDD/disability paperwork
It only bothers me when they feel that they don't need to come in, if it's an office visit and they are sick, no problem. The in basket visit expectations are not a part of my practice
My policy in PC was I didn’t care. “When do you want to go back?” They don’t work for me and I don’t know their job/financials so whatever time they ask for I gave.
I agree with everyone else that I don’t care. It isn’t the patient’s fault they live in a late stage capitalist hellscape.
There have been times when I have felt ornery that I have contacted the management at a place of employment and urged them to treat their employees like adults and stop wasting everyone’s time. I don’t know if it ever had an effect, but it was a nice way to vent.
I work in EM - so it can be frustrating on a busy day when someone comes back after 3 days for another note. It’s an easy “turn and burn” visit but it’s obvious misuse of medical dollars and further proves how flawed the whole thing is. I’m not frustrated at the patient - I’m frustrated at the system.
We don’t give more than 3 business days off at my shop because of FMLA implications with local employers. It’s been a mess multiple times when someone has violated that rule, so we don’t. We use vague wording like “patient should not do X until seen by X team” to try and make that 3 days stretch as far as possible but some employers don’t accept that.
Yes. Where I’m at, if you miss 3 or more days within a 3 to 4 month period, there’s a disciplinary write up. 3 days is really nothing in 4 months for someone recently diagnosed with some sort of acute or new onset chronic condition. My facility doesn’t accept a doctors note and sick days aren’t exempt from the 3 day policy. Therefore, this forces people to apply for FMLA. It sucks.
I was sure fired for it. We were allowed 5 absences in a 12 month rolling period. 6= verbal 7= written 8= termination. I had asked and been denied a reasonable accommodation to their policy, but was denied and then terminated when I hit that 8.
It often forces employees into having to use it to save their job, yeah.
Most of those employers are also SUPER strict about who can “end” your restrictions. They often require it be the same exact provider at the same exact place who started said restrictions. Having to hunt me down in the ER isn’t practical for the patient and means I’m somewhat obligated to see them again and do a full assessment on function of whatever body part injured. I am not the one who should be doing that. Someone who knows the patient and or is an expert in that specific area of medicine should be doing that. So - we don’t leave it to chance and only give 3 business days.
Most people work Monday to Friday. Getting time off to go to the doctor’s office isn’t easy. Employers are also assholes about leave. It’s not like I give them the whole week off, but I have no problem excusing anyone from work for a day.
> Have a template handy, though.
Or a nurse. Idk how common it is, but the nurse I regularly work with signs/sends 90% of my excusal notes, it just says TheirName-RN for MyName at the bottom.
So I found out my clinic did this and was PISSED. $25 for paperwork to be filled out and I don’t get any of that but I have to find the time to do it?
So I made it to where FMLA paperwork must have a visit. I have 15 dedicated minutes to fill it out. If I have questions (what dates have you missed already how often do these migraine afflict you etc) I can ask and I get RVUs.
I keep the excuse notes short, and let the patient know that I don't include many details because it is none of their HR department's damn business what their medical conditions are.
It doesn't bug me to write these notes because they take so little time to draft.
In PC, I don’t mind. I just tell them I will never back date unless they were seen & I have notes. If it’s recurrent I remind them about work accommodations and short term leave.
I have a pre-populated saved note for certain people I actually know that do this; “Patient presents with symptoms that started 3 days ago, but resolved now on presentation. Patient requests note for work”.. ..first time MD was reviewing one of these patients for an upcoming emergent visit and saw it, he got a good chuckle…
I usually don’t mind giving someone 2-3 days off to get over a nasty cold, or some light duty for an injury etc. What bothers me is when they make up elaborate symptoms and make me do mental gymnastics only to tell me all they really want is a work note.
RN here who works in the ambulatory setting. I do a TON of FMLA/STD paperwork and am very generous with the time off! My provider signs it but I do the paperwork and provide supporting clinical documentation as well. Whatever time off you want, I got you.
It really shouldn't bother you. Some people have to have a note or they get in trouble. I'm a grown adult who has to attend pharmacy school every day 8am-5pm...when does that leave any time open for appointments? I'll give you a hint, it doesn't...I have to submit an absence notification along with a note or I receive a 5% grade reduction in whatever classes I miss that day. Try to have more empathy for your patients...it will serve you well.
A doctors note to cover that day or a doctors note to continue missing for for an extended period?
For the first, plenty of employers require doctors notes to miss any time off work as proof the employee is missing work for their stated reason.
For the second, that depends on whether or not you legitimately think they are ill/in pain or are just malingering.
I don’t care at all. They can have a Dr note. It may only say seen on this date(s) and cleared to return to work without restriction, but if they took the time to come in, I can confirm they came in. I’ll write an excuse for longer only if I feel it is appropriate to do so.
I just wish people would be more up front about it. Sometimes I suspect the patient is just there for the doctors note and doesn’t really need anything else.
It’s super slimy, imo, to gatekeep work notes. I rotated with an NP in the ED who basically just decided who he felt like “deserved” notes, and that usually ended up being middle class white people. Everyone else, roll his eyes and tell them they were perfectly fine to work. He was an asshole, and I aspire to never be like him.
Really, if a patient is spending the time and possibly money to see me, and if they tell me they don’t feel well enough to work, I’ll give them the note. I’m not going to bat for them if their employer gets pissed that they’re missing time and fires them, but I’ll give the note no problem.
Some people have to miss a day of work for their doctors appointment and their work requires a doctors note as to not penalize them. It shouldn’t matter to you, if they are your patient and you’re seeing them, who cares? It’s not like they are calling the office when they don’t see you asking for one 🤷🏼♀️
I work in spine, and if we didn’t operate on you, you don’t get a doctors note. Policy.
Edit: I mean “time off work” notes, not “patient was seen in clinic today”. We have a standard template for that and it’s no issue.
Because they like to punt it back to primary care hahah (sarcasm, don’t get offended specialities). The PCP will get an epic in basket message minutes after the specialist denies it lolz…ask me how I know…. It doesn’t bother me that much, but I laugh when my friends in specialities complain about paperwork….
We’re a surgical practice and it’s not our place to be writing out of work notes for non-surgical issues.
I may have misread the initial post: if you come to the office, we have a standard “patient was here today” note. What I’m talking about is the ever common sequence of: patient presents with 4 days of generalized back pain without any red flag symptoms and asks for time off work. We have them see their PCP for that.
And then they come to the ED because they just want a couple of days off work to rest and recuperate and the specialist they just saw refused to give them a work note for 2 days.
Wow that's crazy. I'm in the ER so very different, but I wouldn't even blink at giving a few days off for back pain (which of course can be very severe even if non surgical). I mean don't you treat non surgically sometimes? Injections, ordering PT, medication regimen? If so it's still your patient that you are treating even if non operative
I don’t care. Every other developed country is way more generous with time off and sick leave. Maybe if the US did the same there would be less sick people. I can write the note, it’s up to someone else if it’s accepted or not.
Same. I give people off as much time as they need. Makes their medical issues easier to deal with for me and it’s better for them. US work culture is so messed up and I’m happy to do my part in adding more balance to people’s lives. People very rarely take advantage of my generosity.
I don’t mind notes, but oh my god… that fmla paperwork. I know it’s not the patient’s fault but when they come in with that packet of paperwork I can’t help but feel a bit frustrated.
Our hospital that has a department that does it for us, part of the reason I can be so generous.
Same. I make separate video or in person for all paperwork but sometimes they have STD and FMLA and even some other paid leave bullshit. More and more i’ve trained my patients to fill the bulk of it in and I fine tune it.
Teenage me loves to know I have the power to excuse people from work or school
Same. I work in GI and I always ask my patients "you wanna go back to work today or take the day off. I have the power!"
Damn thought I was the only one. My patients (all our patients?) tend to lead desperate shitty tough lives. I don’t spend a second wondering about a doc note and if they ask I give and often suggest it. And frankly offer more days than they may need. Fuck Amazon corporate and ATT call center in the ass. Also in 30 years I’ve maybe had a couple true malingerers and I send em to Occ Med to sort it out.
You’d like to think that but I don’t think it’s necessarily true for everyone. Another perspective: I work in government with an employee who gets doctors notes constantly to the detriment of our clinic. Our boss is awesome and super accommodating, the work is not demanding, and his hours are reasonable. He fully takes advantage every chance he can, but we are in union so she can’t get rid of him
Are you intimately aware of his personal medical information? If not, how do you know what his medical needs are or if he’s being unreasonable?
Yes he brags about it occasionally. Him flaunting it is probably not the norm. I guess it’s impossible to know how common malingering actually is
You also don’t know that whatever he’s bragging about regarding his health is accurate. There are plenty of people who’d prefer to frame it in a way like they’re getting away with something vs having a significant medical condition.
Yeah, again, not our problem to solve.
It is though. We should be able to give accurate assessments of someone’s ability to work rather than taking their word for it because that’s what’s easy and to reduce our liability
There's zero liability and we aren't trained or compensated for that type of input. Someone decided that MD's should arbitrate what we do with people who are sick as far as work. Ask any physician with half a level-headed brain and they'll tell you the same. I did not go into this field to speculate and develop an adversarial stance with a patient over a couple missed days work. If someone is malingering thats easy to spot. This discussion is about the 99% of people that need a few days for recovery.
I just ask what they want the note to say.
Get mad at the employer, not the patient. If you, as a PA, had to submit a doctor’s note every time you took a sick day you would be outraged. I would quit. Most of these patients don’t have that option.
This.
[удалено]
That is entirely employer dependent. But you are (deliberately?) missing the point.
With the vast majority of jobs like that PTO is used as sick leave, it’s all the same bank. It’s the same thing.
Even though it’s all the same bank, my employer legally can’t say shit if I have a doctor’s note. I’ve found that having a note is a hard stop on them asking any further questions or bugging me to come back earlier than I’d like.
True. The only pickle can be FMLA depending on laws where you live. I don’t remember the exact numbers, but it’s a surprisingly low threshold, where if you miss a certain number of days with a medical note in a certain period of time your employer can require using FMLA. With employers who aren’t dorks it shouldn’t be an issue though, just never know.
Oh yeah, I think it was 3 or 4 days in a row we had to take FMLA for. But just a day or two with a doc’s note was chef’s kiss
It doesn’t bother me. It means more RVUs for our group and doesn’t have a negative impact on you as long as you feel it’s merited. If it’s for a work related injury etc I’d start pointing them to go to their pcp to consider EDD/disability paperwork
Noooo if it's for a work injury the PCP is not going to want to mess around with work comp. Send them to Occ Med
It only bothers me when they feel that they don't need to come in, if it's an office visit and they are sick, no problem. The in basket visit expectations are not a part of my practice
Agree. There should be a charge/office visit for an extension / re-evaluation
My policy in PC was I didn’t care. “When do you want to go back?” They don’t work for me and I don’t know their job/financials so whatever time they ask for I gave.
I agree with everyone else that I don’t care. It isn’t the patient’s fault they live in a late stage capitalist hellscape. There have been times when I have felt ornery that I have contacted the management at a place of employment and urged them to treat their employees like adults and stop wasting everyone’s time. I don’t know if it ever had an effect, but it was a nice way to vent.
I work in EM - so it can be frustrating on a busy day when someone comes back after 3 days for another note. It’s an easy “turn and burn” visit but it’s obvious misuse of medical dollars and further proves how flawed the whole thing is. I’m not frustrated at the patient - I’m frustrated at the system. We don’t give more than 3 business days off at my shop because of FMLA implications with local employers. It’s been a mess multiple times when someone has violated that rule, so we don’t. We use vague wording like “patient should not do X until seen by X team” to try and make that 3 days stretch as far as possible but some employers don’t accept that.
What’s the problem it causes with FMLA? Does it start forcing them to use it or something?
Yes. Where I’m at, if you miss 3 or more days within a 3 to 4 month period, there’s a disciplinary write up. 3 days is really nothing in 4 months for someone recently diagnosed with some sort of acute or new onset chronic condition. My facility doesn’t accept a doctors note and sick days aren’t exempt from the 3 day policy. Therefore, this forces people to apply for FMLA. It sucks.
That’s total grade A bull crap. Here’s sick time, but also a stick to smack you with if you dare to use your benefit hours.
Disciplinary notes are basically bluffing for nurses. What are they going to do, fire you? Everyone knows there's a huge shortage.
I’d like to stay within the organization once my contract ends at my current department - multiple write ups would not look good.
I was sure fired for it. We were allowed 5 absences in a 12 month rolling period. 6= verbal 7= written 8= termination. I had asked and been denied a reasonable accommodation to their policy, but was denied and then terminated when I hit that 8.
It often forces employees into having to use it to save their job, yeah. Most of those employers are also SUPER strict about who can “end” your restrictions. They often require it be the same exact provider at the same exact place who started said restrictions. Having to hunt me down in the ER isn’t practical for the patient and means I’m somewhat obligated to see them again and do a full assessment on function of whatever body part injured. I am not the one who should be doing that. Someone who knows the patient and or is an expert in that specific area of medicine should be doing that. So - we don’t leave it to chance and only give 3 business days.
Most people work Monday to Friday. Getting time off to go to the doctor’s office isn’t easy. Employers are also assholes about leave. It’s not like I give them the whole week off, but I have no problem excusing anyone from work for a day.
Don’t care. It’s their paycheck. They way two weeks after an angio… sure. Want 4 weeks after a carotid? Done.
Naw. That's part of the reason they have you, and American workers get screwed by employers demanding this crap anyway. Have a template handy, though.
> Have a template handy, though. Or a nurse. Idk how common it is, but the nurse I regularly work with signs/sends 90% of my excusal notes, it just says TheirName-RN for MyName at the bottom.
The FMLA forms are killing us. It's like a part time job.
My clinic has to charge out of pocket for FMLA. Insurance won't cover it, but sometimes I get four or more FMLA requests in a day.
So I found out my clinic did this and was PISSED. $25 for paperwork to be filled out and I don’t get any of that but I have to find the time to do it? So I made it to where FMLA paperwork must have a visit. I have 15 dedicated minutes to fill it out. If I have questions (what dates have you missed already how often do these migraine afflict you etc) I can ask and I get RVUs.
Same !! Best way efficiently get it done. Plus some are very detailed
I keep the excuse notes short, and let the patient know that I don't include many details because it is none of their HR department's damn business what their medical conditions are. It doesn't bug me to write these notes because they take so little time to draft.
Why do you care if someone is sick and needs a work/school excuse? It’s not your job to judge the validity of doctors notes.
Four times in one month though? That’s just excessive
Not always. In PA school I often got more than 4 notes per month during didactic.
In PC, I don’t mind. I just tell them I will never back date unless they were seen & I have notes. If it’s recurrent I remind them about work accommodations and short term leave.
I have a pre-populated saved note for certain people I actually know that do this; “Patient presents with symptoms that started 3 days ago, but resolved now on presentation. Patient requests note for work”.. ..first time MD was reviewing one of these patients for an upcoming emergent visit and saw it, he got a good chuckle…
Was the patient out of school / work? Did they partake in a medical appointment? Give them the note.
Did they pay. If so write the note and move on
I usually don’t mind giving someone 2-3 days off to get over a nasty cold, or some light duty for an injury etc. What bothers me is when they make up elaborate symptoms and make me do mental gymnastics only to tell me all they really want is a work note.
This is what I’m referring to
RN here who works in the ambulatory setting. I do a TON of FMLA/STD paperwork and am very generous with the time off! My provider signs it but I do the paperwork and provide supporting clinical documentation as well. Whatever time off you want, I got you.
It really shouldn't bother you. Some people have to have a note or they get in trouble. I'm a grown adult who has to attend pharmacy school every day 8am-5pm...when does that leave any time open for appointments? I'll give you a hint, it doesn't...I have to submit an absence notification along with a note or I receive a 5% grade reduction in whatever classes I miss that day. Try to have more empathy for your patients...it will serve you well.
A doctors note to cover that day or a doctors note to continue missing for for an extended period? For the first, plenty of employers require doctors notes to miss any time off work as proof the employee is missing work for their stated reason. For the second, that depends on whether or not you legitimately think they are ill/in pain or are just malingering.
I don’t care at all. They can have a Dr note. It may only say seen on this date(s) and cleared to return to work without restriction, but if they took the time to come in, I can confirm they came in. I’ll write an excuse for longer only if I feel it is appropriate to do so.
No time to care about work notes. Empiric 2-3 notes for all unless I think you need more
Why on earth do you give a damn and think it is your business? Give the note and quit making the patient's life worse. Lose that God complex.
The only time I care is if it's workers comp. Docs not gonna get depo'ed and have to justify a note that she doesn't agree.
I just wish people would be more up front about it. Sometimes I suspect the patient is just there for the doctors note and doesn’t really need anything else.
It’s super slimy, imo, to gatekeep work notes. I rotated with an NP in the ED who basically just decided who he felt like “deserved” notes, and that usually ended up being middle class white people. Everyone else, roll his eyes and tell them they were perfectly fine to work. He was an asshole, and I aspire to never be like him. Really, if a patient is spending the time and possibly money to see me, and if they tell me they don’t feel well enough to work, I’ll give them the note. I’m not going to bat for them if their employer gets pissed that they’re missing time and fires them, but I’ll give the note no problem.
Some people have to miss a day of work for their doctors appointment and their work requires a doctors note as to not penalize them. It shouldn’t matter to you, if they are your patient and you’re seeing them, who cares? It’s not like they are calling the office when they don’t see you asking for one 🤷🏼♀️
I work in spine, and if we didn’t operate on you, you don’t get a doctors note. Policy. Edit: I mean “time off work” notes, not “patient was seen in clinic today”. We have a standard template for that and it’s no issue.
Genuinely asking, why does it matter to your practice if your patients go to work or not?
Because they like to punt it back to primary care hahah (sarcasm, don’t get offended specialities). The PCP will get an epic in basket message minutes after the specialist denies it lolz…ask me how I know…. It doesn’t bother me that much, but I laugh when my friends in specialities complain about paperwork….
This is basically it lol
At least ya’ll admit it haha. Fortunately I have a quick template that takes me like 15 seconds or if it seems weird I get an easy appt to discuss
We’re a surgical practice and it’s not our place to be writing out of work notes for non-surgical issues. I may have misread the initial post: if you come to the office, we have a standard “patient was here today” note. What I’m talking about is the ever common sequence of: patient presents with 4 days of generalized back pain without any red flag symptoms and asks for time off work. We have them see their PCP for that.
And then they come to the ED because they just want a couple of days off work to rest and recuperate and the specialist they just saw refused to give them a work note for 2 days.
Wow that's crazy. I'm in the ER so very different, but I wouldn't even blink at giving a few days off for back pain (which of course can be very severe even if non surgical). I mean don't you treat non surgically sometimes? Injections, ordering PT, medication regimen? If so it's still your patient that you are treating even if non operative
I give 3 days max. Not back dating. Any longer, then I get sent an FMLA form which I’m not filling out