Notes to doctors writing notes

Family doctors beware. Although your propensity to empathize with your patients’ plight and advocate on their behalf when writing notes for their employer or disability insurer is admirable, it is dangerous and almost always does more harm than good.
An employee arrives in your office anxious and depressed because they feel they are being bullied or harassed in some way at work. Instead of writing a note simply confirming that the employee is absent for a period of time as a result of an illness, you write, “Johnny is unable to work as a result of work-related stress.” Bad move. First of all, getting WSIB for work-related stress is like pulling teeth. It almost never happens and this note is not for WSIB anyway, it’s for the employer. You may in fact leave your patient in a catch 22. WSIB will not cover the absence and the disability insurer will not cover work related illnesses. They use your note to leave you patient with no income.
Just because you say the stress is caused by work does not mean the employer will accept that. Doubtless it will believe it is simply been disciplining Johnny appropriately. Now they believe Johnny has been telling tales out of school about them and antipathy results. While the employer may have been simply satisfied to let Johnny stay off until he is ready to return to work, now their back is up and they are challenging his absence and scrutinizing every note you write. The employer does not need to know the cause of the illness, just that there is an illness keeping Johnny from working.
If Johnny applies for disability insurance because he’s off for an extended period of time, if the insurer gets wind of that note they will scrutinize Johnny’s claim closely and likely deny it. They will stereotype Johnny as someone who is trying to use them as a way to avoid difficult realities in the workplace and not as somebody who is truly disabled.
So now you’ve got the employer angry and your patient will likely be denied disability coverage. All because you added the words “as a result of work-related stress”.
In a further misguided effort to advocate on behalf of patients, doctors sometimes write notes which read something like this: “Johnny can return to work but not in the department in which he was previously employed” or “not in the position in which he was previously employed” or “not reporting to the manager to whom he was previously reporting”. Johnny has told you horror stories about how he has been treated by management in the job he’s got and he’s trying to use your authority to get him transferred. You may honestly believe that that would be the best thing for Johnny’s health. If you are going to make suggestions to the employer about how Johnny can be accommodated, they must be backed up by objective limitations. With respect, it’s not enough that you say it must be so. For good or for bad, the 1960s are long gone and a doctor’s advice is not gospel.
If there are medical limitations that keep Johnny from doing his old job, you should list them specifically and objectively. How the employer accommodates those limitations is their business, not yours.
There are some situations in which an employee needs to be in a less stressful job than the one they had before they became ill as a result of mental health issues or, often, cardiovascular issues.
While it is true that the employer has no right to know the diagnosis, unless there is something extremely personal about the diagnosis it’s often very productive to disclose it, with your patient’s consent. If you don’t, your patient may be put through the bother of having to attend upon a doctor hired by the employer to confirm the limitations. Often that can be avoided by simply being forthright about exactly what’s going on without trying to blame the employer or tell them exactly what they should do.
An employer can require the following information:
  1. Is Johnny medically unfit to do his job?
  2. Is Johnny following the course of treatment you have prescribed?
  3. Is there any prognosis possible for Johnny’s return to work?
  4. Is there any accommodation that the employer can provide to facilitate Johnny’s earliest possible return to work?
Of course, if the employer asks you these questions directly you need a signed consent from your patient. If the employer asks through your patient and you are simply giving a letter to your patient with which they can do what they like, you don’t need a written consent.
When it comes to attributing the cause of your patient’s illness or disability to actions or behaviour of the employer, the less said the better. On the other hand, when it comes to revealing the diagnosis, not the reasons for the illness, sometimes sharing will mean that your patient will be bothered less by the employer when they are off ill and you will be asked to write fewer notes.

Ed Canning is a partner practicing in the Labour & Employment Group at Ross & McBride LLP.

As published in the Hamilton Spectator, April 18, 2011
Ed Canning
Ed Canning
P: 905.572.5809