When Sick is not Sick Enough

Everyone gets sick once in a while, even sick enough to miss work for a day or two. So you go to the doctor and she gives you the once-over, prescribes a round of medications, recommends bed rest and says you’ll be feeling fine in time to go back to work on Monday. Monday? But Monday your son has a school party and there’s a huge sale at your favorite store Tuesday morning. You cough a little louder and suggest to your doctor a couple more days in bed might be better.

This scenario is familiar to Dr. Abigail Zuber, a primary care physician who wrote of a similar dilemma in a New York Times article, “The Lies We Tell In The Exam Room.” It’s not the big things that are troubling. It’s the little notes she is constantly asked to write to employers, giving employees a little more time off when they’re really well enough to go back to work.

Honesty between doctor and patient is essential to good health care. What’s an extra day off? Patients don’t always tell the doctor everything. They may minimize symptoms or pain to avoid medical tests and their high cost. Doctors may want to soften the blow or downplay the more serious side of an illness with a variety of possible outcomes. When a third party enters the equation, the lines between a little white lie and downright dishonesty get a little murky. 

That third party can be an employer or the insurance company. Surveys say that doctors routinely tell the insurance companies blatant lies on behalf of their patients. These include writing referrals for specialists or expensive tests or giving a particular diagnosis for a condition a patient doesn’t have so the insurance companies will pay for them. Routine checkups can become emergencies; costly medications are prescribed for illnesses a patient doesn’t have.

Some physicians bend to pressure from patients, and others play Robin Hood, taking from insurance companies that refuse to pay for an additional, experimental treatment or medication that can mean the difference between life and death. Too much of a good (bad) thing only makes insurance companies tighten up and make it more difficult to prescribe tests or medications for those who really need them. Fraud drives up costs that result in higher premiums and deductibles. 

Dr. Zuber isn’t alone in this deceptive practice. And, she admits that the more notes she writes the easier it gets.  Too much of a good thing can be bad for her patients. Employers whose employees seem to always have extended illnesses and recovery times may start to notice a pattern and become suspicious. Absenteeism ruins productivity and makes it difficult to run a business. Employees could face disciplinary action or even termination for excessive absenteeism if employers find out they are padding their recovery time. 

While any deceptive practice erodes the ethical and moral fiber of the medical profession, a bigger question should be, why is working so inflexible that employees have to resort to collaborating with their doctors to get a little more time off? Isn’t an extra day off to take care of personal matters another form of healthcare? Isn’t an extra day off a form of mental health therapy or stress relief that can be as effective as medications to help a patient feel better? Doctors heal in many ways. Taking a little latitude in writing a “back to work” note may have positive side effects and help get an employee back to work a little healthier and happier.

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