Sick Notes – Dr. John Ross

Sick Notes

Feb 18, 2020    |    Dr. John Ross MD FRCPC

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We received a call recently from someone asking for a ‘doctor’s sick note’ that was requested by her employer for a recent three-day absence from work. We get these calls from time to time. I see some telemedicine companies advertising ‘get a doctor’s note’ as one of their prime services. I was just speaking to a marine transport company yesterday about the difficulty some of their employees have in accessing a doctor to provide a ‘sick note’ following a lost time illness or injury.

As an Emergency Physician who has reflexly written hundreds, maybe thousands of ‘sick notes’ over my career, I question the value of the ‘sick note’ in real life. Is it just a really annoying surrogate process related to problems with the employee-employer relationship that needs to be replaced?

‘Annoying’? Yes, in fact all parties to the sick note get annoyed. First the employee must make an appointment or find a physician willing to provide the note. They cannot return without it. That requires time and often waiting which increases the lost time. Sometimes employees contact a doctor after five or more days off due to a resolving viral illness and expect the doctor to sign a note verifying they were too sick for work five days ago. How is that possible to assess?! Doctors say that requiring someone with a potentially communicable but self-limited illness to share their ‘germs’ with people in the waiting room puts others at risk, interrupts rest time at home, and uses up time needed for patients who would actually benefit from a doctor’s care.

Sick notes are an ‘uninsured service’ in all provinces, meaning doctors must charge patients for the time it takes for an assessment and paperwork. Doctors Nova Scotia has a form letter that they recommend physicians send to employers requiring sick notes informing them that the employer, not employee, should pay for the service and they will invoice accordingly (see below.)

Some employers suspect doctors provide sick notes too liberally or for more time than they think is reasonable, but they want it anyway. Some companies mandate detailed, multi-page assessment forms be completed by bewildered doctors.

Most doctors, other than Occupational Health specialists, have limited or no training in assessing lost work time requirements, so they guess what is ‘reasonable’. They often do not ask about other work duties that are available.

It seems the ‘sick note’ requirement is the result of a lack of trust in the employer-employee relationship. The surrogate solution is the annoying non-evidence-based doctor’s signature, which if challenged, all three parties would agree is partially or completely useless. It consumes considerable time and lost productivity of all three parties. It needs to stop.

There are four reasons an employee will miss work due to a medical cause:

1. A scheduled appointment to see the doctor for self or family
2. An unexpected illness or injury involving self or family
3. ‘Mental health’ day(s) due to work stress or lack of job satisfaction results in lost time
4. Related to number 3 is an employee with a minor illness or injury who exaggerates the problem for a multitude of reasons.

Hopefully by now we can all see the problem. What are the alternatives?

1. Large companies with human resources professionals should have an occupational health and wellness resource available that understands the company culture, work type, options, and can assess sick or injured employees according to accepted and well communicated company standards.
2. Small companies could establish a peer review group of employees that assesses the reasonableness of lost time minor illness or injuries. More serious problems can get input from medical and surgical specialists as usual.
3. High stress work places, too often the highest users of doctors’ sick notes, need to find more common ground between employer and employee. Employers that do not respect or trust their employees, have unsafe or unhealthy work places, or pay poorly, and employees who try to cheat employers have relationship problems that cannot be solved by the simple but virtually meaningless doctor’s sick note. Doctors cannot referee, police, or treat an unhealthy work place.
4. Voluntarily adopt what many companies already have and the government of Ontario has proposed as part of the The Fair Workplaces and Better Jobs Act. They are recommending a ban on requiring sick notes for absences of less than 10 days. A growing number of companies have eliminated the requirement altogether.

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