Doctor’s Notes Are Stupid

Doctor’s Notes Are Stupid

One of the significant burdens for doctors, especially primary care doctors, is the writing of doctor’s notes.  These notes range from the get out of school or work, because I am sick note, to handicap placards, to disability applications, to requests for payment for medical equipment and services, to refunds of money because they could not avail themselves of a service due to being ill, to pharmaceutical prior authorizations, and to the insane Family and Medical Leave Act (FMLA) forms.  

Those in power, in our country, have rejected the concept of personal responsibility.  The idea that each individual, with the assistance of their family, needs to provide for their own needs, plan for the future and take responsibility for the consequences of failing to do so is a foreign, even offensive concept.  Instead we have come up with all kinds of programs.

These notes are demanded by schools, employers and government as an attempt to solve the problem that a significant percentage of human beings will try to dishonestly accumulate as much benefit as they can for themselves.  Since our society has decided that no individual, with their family, is responsible for solving their own problems, but rather it is the government’s responsibility to solve everyone’s difficulties, we do have the true problem of deciding who has an approved right to take other people’s  time and money. 

In the area of health issues, our society has assigned to physicians the responsibility of being truth detectors.  They are expected to do what no one else is willing to do, that is determining who is legitimate. I would argue that it is impossible for physicians to fulfill this responsibility and forcing doctors to pretend they have this ability is stupid.

1. Many specialists and emergency rooms/urgent care refuse to complete these forms, thus the patients desperately come to the bottom of the food chain, the primary care physicians, to get them completed, even if we are not involved in the care being rendered. People are told they have to get these assorted forms from their doctors and thus I am forced to complete nonsensical forms.  If I refuse to participate in this insanity, the result will be very angry patients.
2. Physicians are the only profession that requires its members to make their customers angry.  When these forms are brought to me, a majority of the time they are for claims that are not objectively apparent.  I then have to choose between telling the individual that I cannot corroborate what they are claiming and be met with anger or tears and accusations or I can assume the individual is telling the truth and sign/complete the forms.  Either option puts the doctor in a very difficult position and certainly does not accomplish what the paperwork is supposed to accomplish, that of verifying the claims of the patient.
3. Parents of students who miss days of school are told they have to get doctors notes for days missed.  If I tell them I cannot give notes for days they were not seen in the office, the response is it is my fault if their children fail school (in education today, it is a greater harm to have unexcused absences than to be uneducated).  
4. Being a doctor does not grant one extra skill in discerning truth from lie.  I cannot tell any more than human resources personnel or school officials if parents or employees are telling the truth or lying.  The reality is these officials will not take responsibility for making a judgment on the claims being made. They want to pass that responsibility off to the doctors.  Then they want to have the right to challenge our decision. You cannot have it both ways.
5. Graduating from medical school does not give one the ability to see the future.  I will often say to patients that when I graduated from medical school I missed the table where they were handing out the crystal balls and missing that table has severely handicapped my practice of medicine.  I cannot foresee the future. I have no idea how frequently they are going to be ill or when they are going to be better. Nevertheless these forms routinely ask me to tell when someone is going to be improved enough to return to work or how often they are going to miss work.  It is stupid to be asking these questions and any answers we put down are meaningless, but those blanks have to be filled in or the forms will not be accepted.
6. The entities requiring the paperwork do not support the doctors.  Pharmacy benefit managers make us guess what medications are covered and then constantly change which ones are covered.  When we complete forms as honestly as we can and it does not indicate what the patients want, the human resources people, insurance companies and schools do not tell their employees/clients/parents that they do not meet requirements for the benefit.  Instead they tell their employee/client/parent that they were turned down because their doctor did not fill the paperwork out properly.
7. This stupid paperwork mandates visits to the doctor when students should be home in bed rather than spreading their germs around.  Employees have to come in for multiple visits to update the paperwork, not to get new treatment. All of this costs money and wastes everyone’s time.
8. The forms, themselves, are absurd.  This is particularly true in the area of disability forms.  The same question is asked at least three times. My divining power is demanded to predict the future and I am expected to know how many times or time someone can bend over, pick up, stand up, sit down, etc. over 1 hr., 4 hrs., and 8 hrs.  WHO KNOWS?

Do I expect this stupid paperwork to go away?  I do not, but that does not mean I cannot point out how stupid and pointless is all of it.