Every family doctor knows that they inevitably have a role to play in their patients’ relationship with their employer. Absences from work of 3 days or more usually result in the employer demanding a “note from the doctor” as a matter of rote.
Employers who pay for sick time, a benefit not required by law, will sometimes resort to requiring a note for every sick day when they become irritated with a constantly absent employee.
In most circumstances, a simple note on a prescription pad saying, “Joe is absent from work on this date due to illness” will suffice. The employer just wants to make sure that there was some sort of illness involved and that the employee was not just enjoying a day off in the sun. All of this, I am sure, can be extremely irritating to over-worked family doctors who end up having to take appointments for no good reason. The doctor and the employee both know it’s just a cold or the flu that will pass. Nonetheless, a trek down to the doctor’s office becomes involved. Some doctors charge a nominal fee for writing those notes, more as an expression of their irritation than as a money-making enterprise.
Encourage your patients to ask the employer to reimburse them for that cost. There is nothing requiring the employer to do so, but it’s worth a try. But be careful here. Encouraging your patient to get in a battle over a $15 fee with their employer might endanger their future employment and do more harm than good.
Most family doctors are aware that the employer should not be asking for a diagnosis. When there is an extended absence involved, however, the employer does have the right to ask the following 4 questions: 
  1. Is the employee suffering from a medical condition that renders them incapable of attending at work and doing their job?
  2. Is the employee following the course of treatment prescribed by the doctor?
  3. Does the doctor have an estimate as to when the employee might be able to return to work?
  4. If the employee can return to work, are there any limitations that apply and is there anything that the employer can do to make changes to the job or hours to facilitate the return to work?
    For notes like this that take more time and effort, an employer should be offering to pay the reasonable fee charged by the doctor. This is especially the case if the employer is asking the doctor, as they should be, to review some sort of a job description before answering these questions. Employers asking for this information should want to avoid a situation where two weeks after the request they get a call from the employee saying they can’t afford the $50 to pay the doctor for doing the letter.
    Never become your patient’s advocate. I can’t remember how many times I’ve cringed when reading a doctor’s note that says something like, “Jane cannot attend at work right now as a result of work conditions/harassment in the workplace/intimidation by the employer.” This is always a mistake that hurts your patient.
    First of all, Jane is usually complaining about her boss and I’ve never heard of one situation where a true bully will back off because they receive a note from Jane’s doctor castigating their behaviour. They know that the doctor is simply repeating what Jane has told them and that just because a doctor wrote it does not mean that it is true. If anything, they are irritated that Jane has been complaining about them to somebody else.
    Secondly, if Jane is off for a long time and ends up applying for disability insurance, the doctor may have unwittingly killed the claim. Most disability insurance contracts state that they do not cover injuries or illnesses caused by or as a result of the workplace. The doctor has just given them an easy out and they can deny the claim without fear of being successfully sued.
    If Jane then turns to WSIB and applies for Workers Compensation, she will be told that she can’t get paid for her anxiety and depression as WSIB just doesn’t accept those kinds of claims unless there has been some truly traumatic event in the workplace, like witnessing a serious injury or death in the workplace.
    No matter how outraged you feel on behalf of your patient, stick to the facts that relate to the illness and the patient’s ability to attend at work.
    It is an implied part of every employment contract that if the employee shows up to work they will be paid. It is also an implied part of that agreement that the employee will not be absent from work without valid justification. Employers have the right to seek justification for the absence. This is the dilemma that doctors get caught up in. As irritating as it is, I really don’t see it changing any time soon. Employers are starting to ask for more detailed information from doctors than they used to. The medical profession has to take some responsibility for this trend. There are, unfortunately, too many doctors that will write a note for a patient excusing them from work at the drop of a hat.
    Doctors are charged with having a caring relationship with their patients. The relationships are long term ones. I can imagine that it must be difficult to say no to somebody you’ve known for years who drops by the office to say that despite not having any of the typical symptoms of serious anxiety or depression, they are feeling “overwhelmed” and think they need a week off work.
    My sympathy and the sympathy of many employers for the doctor’s dilemma starts to fade, however, when the absences are constant but there does not appear to be any real underlying illness or mental health condition but still the notes keep coming.
    Finally, while there are very few circumstances where the employer has a right to know the diagnosis, sometimes refusing to disclose the diagnosis can do more harm than good. When acting on behalf of employees, I have seen a number of situations where an employer has been able to duck out of a successful human rights complaint on the basis that they did not know their employee was suffering from any significant disability.
    Crohn’s Disease, for example, is a debilitating life-long condition that waxes and wanes. Why not just tell the employer that the condition has been diagnosed and that the employee may need time off from time to time and be unable to work?  Bringing the employer into the loop may eliminate their concerns about the employee malingering. The employer will be far less likely to require the employee to constantly troop down to the doctor’s office every time they need a few days off.
    As published in the Hamilton Spectator, April 26, 2008
Ed Canning
Ed Canning
P: 905.572.5809