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    Work Notes, School Notes, PE Notes - Aaaargh!

    When did we become a society that requires doctor’s notes for everything? I spend a great deal of my precious day writing note after note to coaches, teachers, day-care providers, and bosses. Is this really necessary?

    I have always felt that people are basically honest until proven otherwise. When a responsible employee is required to submit a note to his/her boss just to confirm an illness, I find this very problematic. If I have seen the patient for a particular illness, I will write the note, although I think it is ridiculous that adults have to do this. In generations past, if you were too sick to go to work, but not sick enough to pay for a medical visit, then you just stayed home. Now, people have to pay for a medical visit just to get a work note sometimes.

    Yesterday, I had one of the “no show” appointments. Someone made an appointment, but didn’t have the courtesy to call and cancel it. When I reviewed the records, I discovered that this person has no showed for eleven visits! I am surprised that the PCP (primary care provider) has not discharged them from our practice, since they are costing us a considerable amount of money. When someone no shows, they prevent someone else from using that appointment slot. I find this rude and inexcusable. Sure, we all forget and miss an occasional appointment. We are human. But, eleven appointments… this person has a problem. I suspect this is the same person that will call me in a few days asking for a note for her employer because she was “sick”… apparently too sick to come in, and too sick to pick up the phone and cancel her appointment.

    Someone with chronic work absenteeism, someone that tends to be sick only on Mondays or Fridays, or someone who becomes too ill to work the day before a long holiday weekend, would certainly raise my eyebrows as a boss. For these yahoos, I would require a note, too, or better yet, provide them with a note – an official DCM (Don’t Come Monday, you’re fired).

    State and federal employees always ask for notes. Teenagers who work for fast-food places ask for notes. People who are on probation for chronic absenteeism ask for notes.

    This is football season for the high schools. Coaches are scrambling to get their players ready for competition, so many have practices twice per day now. If a player misses a practice, the coaches require a note to prove they were ill. A note from the parents is apparently not good enough. They want a “doctor’s note”. I get so tired of doing these that I have become passive-aggressive, often writing “Jim was sick today” and sign my name. I don’t feel that the coach has any business knowing the nature of the illness if it does not affect the player’s performance or put others at risk for a contagious illness. There are days that I would like to write, “Jim has gonorrhea and cannot play today.”

    Schools are probably the biggest abusers of notes. It took me a while to realize that these notes are worth big bucks to the school, since an excused absence due to illness still qualifies them for federal matching funds. For instance, a school may get per student per day from the government. If just ten kids fail to show up, the school will lose 0 – perhaps the salary of one teacher (including benefits). When a hundred kids stay home during a flu epidemic; that can add up to a lot of money… and, a lot of notes for me to write.

    For some reasons, teens try to get out of PE. I know, our kids were always asking us for notes. Our oldest son, Josh, wanted a note to get out of PE because of “back pain”. Apparently not realizing what we do for a living, we examined him and determined that he was a malingerer – nothing wrong with his back. We gave him a note for “remedial PE” that did not include running, so he was fine. He was fine, until the PE teacher decided that if he couldn’t run or play basketball, then he would be reassigned to the special needs class. For two days, our son was in a class with kids in wheelchairs, leg braces, crutches, or with mobility issues because of cerebral palsy. He quickly discovered that his bogus back pain wasn’t really that significant. On day three, his disabling back pain miraculously resolved and he returned to his regular PE class. Some time later, we discovered that he had PE during first period, and it messed up his carefully styled hair!

    Kids with the True Flu (medically-diagnosed Type A Influenza) MUST stay home. As a matter of fact, if they are doing okay, I would prefer that they not come in to our office, either. A doctor’s office, no matter how we try to keep things clean and sanitized, is a great place to spread illness, and a great place to come in with one illness, and leave with another. Here is the Catch 22. If they need a doctor’s note, I have to see them. If I have to see them, I have to have an open appointment or work them in. I often have a dozen more requests for appointments per day than I have open slots. If they can’t get an appointment (to get the note), they go to urgent care or the ER, over-crowding the waiting rooms and over-exposing everyone they meet. I suspect the quest for notes costs our economy billions of dollars per year.

    Daycare providers often think they are medical providers. If I had a nickel for every rash that was supposed to be measles or chicken pox, only to be hives or mosquito bites, I could have retired years ago. My wife and I used to teach a class called “Pediatrics for Child Care Providers” that was required for licensing in our county. We taught thousands of eager child care providers how to properly recognize certain infectious diseases, and how to establish reasonable exclusionary polices. When child care providers exclude your child for suspected pink eye or the plague, the parent has to leave work to pick them up, make a timely appointment for my office (usually the next day, so they miss TWO days of work), and require a doctor’s note before the child can return, then I have to write TWO notes – one for the child care provider since they don’t trust the parent, and one for the boss, also because they don’t trust the parent.

    One study showed that over 80% of all missed days for working women are for the illnesses of their children. It doesn’t take very long for a responsible working parent to quickly run out of sick days just to take their kids to the doctor. If the employed parent becomes ill, they have to go to work sick, where they will expose their fellow workers, who will become sick, inadvertently infecting the kids going to day-care, thus starting an epidemic. They will then show up at my office asking for notes.

    If I were the dishonest, entrepreneurial type, I would have a note vending machine in my waiting room. People could insert a five-dollar bill, type in the days they missed work or school, and out pops a signed note. That is a good idea. The Doctor Note-O-Matic! This would be a noteworthy and lucrative venture. Sorry about that…

    I do have a confession to make. In my teen years, I became quite skilled at forging notes so we could go to the library instead of French class, or a teacher’s signature as proof that we had completed a chemistry experiment. One of my proudest days as a forger occurred when a teacher turned down his actual signature since it did not look like the other (forged) signatures that I had done!

    Actually, I attempted to write my own note in first grade when Gregory and I decided to play hooky and hide in the woods all day. In my youthful naivety, I did not know I would need a note to get back to school the ne
    xt day. When mean old Miss Rider told me that I had to have a note from my mother for missing school yesterday, I truly became sick. After dozens of attempts to replicate my mother’s handwriting, I knew it was not very good. Fessing up and hoping for a one-time only reprieve, my mother was not sympathetic. She actually wrote “hooky” on my note! This would not do.

    I went across the street to my kindly Aunt Norine (now, 95 years old), to see if I could con a note out of her.

    “Why didn’t your mother write this note?” she inquired.

    “She didn’t know how to spell “sick”, I replied.

    My aunt wrote the note and I was ever so grateful. She also made me go to church the next Sunday hoping that I would confess my sins before it was too late. I found that you could pray for forgiveness. Unlike Miss Rider, God didn’t require a note.

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