Down The Pipes

ventilation shaft on a boat

He had just been here last week. Why was he back so soon? 

The tag line on his visit said, “NOT BETTER.”

What do you mean you’re not better?!!?!!?

Somehow, I always feel a bit defensive when patients don’t get better, it is as if the illness has exposed my weaknesses. I have come up short. I know it isn’t logical, but this is the way I feel.

Do they think I did something wrong?

Sometimes they do.

I took a deep breath, burying that defensiveness so it would not show on my face, then knocked on the door and entered. 

“Hey, Doc.” He looked at me apologetically. “They told me I couldn’t work and would have to get paperwork from you.” 

He passed me a thick stack of FMLA forms.

“You couldn’t work? You had said your cough wasn’t that bad. Did it get worse?” 

“The cough got better. Everything was better but I lost my voice. I went to work every day and each day they sent me home. Other people, they just take them off the phones and put them somewhere else. I don’t know why they wouldn’t let me do the same.” He looked ashamed. “I really needed the money. I got a family to take care of.”

For five days his employer told him he couldn’t work because his voice was raspy. Each day he was sent home. Now I had to complete pages of paperwork for FMLA* stating he had a serious medical condition that prevented him from working. 

A hoarse voice does not constitute a serious medical condition. 

And yet, if I did not complete his paperwork, he would lose his job…

I am constantly backed into the corner by employers in various ways. If you want to get rid of your employee, tell them. Do it for legit reasons. Don’t make me the bad guy. Really. But it is so much easier to pass the buck, to let someone else take the fall, to make them do your dirty work for you. 

Look, we like you, but you missed too many unauthorized days. Too bad your DOCTOR wouldn’t fill out your paperwork…

“Please, Doc?” His eyes pleaded with me. 

I completed his paperwork. 

“Hey, maybe you need to start looking for a new job. Just in case, you know?” 

He nodded. He understood.

At least he was being honest. I checked. 

There are plenty of patients abusing the system, too…

*FMLA (Family Medical Leave Act) allows certain employees to take up to 12 weeks off in a calendar year for a serious medical condition or to care for someone else with a serious medical condition. It is unpaid leave but it does make sure you have a job to come back to. For a physician it is about five pages of stupid questions to complete.


69 thoughts on “Down The Pipes

  1. it’s a shitty and cowardly way to get rid of an employee but I’ve done it too. It is easy, preying on their guilt, and it seldom results in further action. I have fired employees the “right” way by building a file, issuing warnings,then suspensions and making sure all the paperwork was done. When it came time to fire, the employee inevitably objected. I’ve been sued, investigated (by various government agencies including Labor Canada, Worker’s Comp, etc) and always found justified. All that takes time and energy and money. I had one guy who fainted while on duty. I sent him to a doctor and when the doctor said he was fine, I called and objected – I got his licence pulled and then told him he couldn’t work for us anymore without a licence. He was a pain in the ass and I was glad to say good-bye and thank you doc.

    Liked by 1 person

  2. Oh uhg, I hate paperwork and the whole system drives me nuts. Once when we didn’t have any insurance at all, we could not take even a single sick day and return without a doctor’s note. No doubt some insurance company came up with this one. It was probably supposed to keep us all, from working while we were sick, but it had the opposite effect, you couldn’t afford to stay home while you were sick because you couldn’t afford to go to the doctor to prove you were now well.

    Liked by 2 people

    • I get people frequently who are completely better but need a note for their job because they were out sick for a day or two and when they went back were told they could not work without a note saying they were seen. They don’t work in healthcare. They don’t work in food services. They are good honest people who don’t just take time off willy-nilly and are not trying to abuse the system. It is company policy because now no one can be trusted….

      Liked by 2 people

      • My point exactly. I currently work for a very small law firm, and my boss has accommodated my UC by letting me take long lunches and drop down to 4 days a week. It’s kept me going so that I can work harder when I’m in the office. But now the firm is dissolving and in order to keep my job, I will need to follow my boss to the largest firm in town – which means working full-time, minimal lunch period, and sick time rules. I may even have to give up my Remicade treatments! I am so not looking forward to it, but jobs here are limited for people in my age bracket. and I’m still a few years away from Social Security.

        Liked by 1 person

      • Cultivate a sense of uncertainty, low value, and mistrust. I think they believe that it makes people work harder but it doesn’t. Not really. There is no reason to be loyal anymore. You are a number, an expendable one at that. I see that in how our own staff is treated and it is extremely frustrating.

        Liked by 1 person

  3. It seems to me like a sore throat is a “serious health issue” if it keeps him from being able to do his job. I think the key word here is “incapacitated”. Also, as I recall, the second visit fulfils a requirement for two doctor visits, under federal FMLA. I’m not sure about state rules.

    Writing “this patient has been under my care” was a ticket for legitimate rejection by my employer (US Postal Service). But writing “this patient has been incapacitated for work” were magic words that fulfilled requirements. Especially when specific physical restrictions were included, such as “no bending, no lifting over 10 lbs, etc.”

    Providing a diagnosis was okay, but could violate privacy laws, and is never a requirement. I never minded that though, when I represented myself, and I encouraged doctors to put a diagnosis in my paperwork. That worked better than anything else in satisfying my employer.

    That’s how my fading memory recollects FMLA law. It’s been a few years, so I could be wrong about some of this.

    Liked by 1 person

    • Technically, they are not incapacitated for hoarseness. Cannot speak on the phone, sure, but there are other duties they can complete. FMLA also specifies serious health condition. The postal service does require the word, incapacitated. I have written those notes plenty. That is not FMLA, though. One trick employers do now is tell patients to get their doctor to complete FMLA paperwork for “in case you get sick at some point”. Something to keep in their pocket. HR tells them it qualifies. Technically it doesn’t. Certain illnesses can, like a terrible bronchitis or asthma attack, not a regular head cold, though. Personally, I feel like employees should be granted a certain amount of discretionary sick leave that they can use as needed without a physician’s authorization. This is the way it used to be. Requiring a doctor’s note for every absence encourages over utilization of the healthcare system. If you have an illness that will require more than your regular sick leave to recuperate from, that is when FMLA should kick in.

      Liked by 1 person

      • I think in the case of your patient with the sore throat, writing something like “patient should not speak louder than a whisper,” or “patient should avoid talking any longer than five minutes per hour” would do the trick for him.

        We’re probably not in agreement about incapacitation. A quadriplegic is not incapacitated to speak on the phone, but is definitely incapacitated for standing, running, jumping, etc. It’s all relative to the work description.

        I’ve never heard of advanced FMLA approval for an acute illness that hasn’t occurred yet. Sounds a bit illegal to me. But I have heard of advanced FMLA approval for chronic or recurring conditions.

        I like your ideas about sick leave. Sure wish you could rewrite the laws. One general argument we union stewards have used is, what is the purpose of sick leave, if you can’t use it when you’re sick?

        Liked by 1 person

      • A quadriplegic who used to do a manual labor job is incapacitated for that job. But an office worker, whose job is not all phone work, is not incapacitated by hoarseness. I work while I am hoarse. Comes down to semantics, I guess. Bottom line, I completed the paperwork stating he could not talk on the phone. I felt like I was pushed into a corner by the employer. Happens a lot.

        Liked by 1 person

  4. What a mess. Like the hoops my clinical psych husband is expected to jump through for his SMI clients to receive SSI. As I type, one of his patients has told him that she will kill herself if her case isn’t approved. Again, what a mess.

    Glad to see you again, Doc! Waving to your littles, too 😀

    Liked by 1 person

  5. Arrrrrrrrrgh.

    One of the biggest changes in my recent life is working for a company that makes me feel … well, safe. I know the job might not be forever. I know changes in the economic tide might see its being cut sometime down the road, but while I am there, I will savor it. This is the kind of thing I cannot fathom happening there, but saw symptoms of many times before.

    I wish I had a way to tell employers like that management articles don’t lie when they say people perform better when they feel safe. The last six months, I’ve learned that, and I’ve seen how much higher I soar in both my work and personal life knowing that I will be held up in healthy times and sick ones. I wish deeply that everyone could know the giving and receiving that.

    Liked by 1 person

  6. I was in a supervisory position for most of my career and only fired three people in thirty years. I found that people with issues responded well to understanding in most circumstances. Employees abusing drugs was the reason for all three of my firings.

    Liked by 1 person

  7. Even though I work in the Health Care industry with a majority of employees being clinically trained, taking sick leave is taboo. We even have policy stating if you have an infectious/contagious illness you are to stay home, you still get asked to come in. We had one diet technician this winter who had to make visits to patients home who came in every morning and hacked her sputum everywhere. She took out her whole department and most of the HR department, including me because we all share the facilities. One girl was hospitalized. This was what we were sending out to patients because we were short handed. One manager who had a gastric bypass done and had huge complications with it had to keep going out for surgery and recovery was fired because they said if the department can get by that much without her, she was not needed.
    However, if you go out to have a kid, take all the time you want. They say that they are extending maternity leave to a year. Keep rolling ’em out and you will never have to work. But if you are an older person suffering from a chronic illness; WATCH OUT!

    Liked by 1 person

  8. My husband works for a large employer, one with 50+ employees, who falls under FMLA. We’ve had to get FMLA paperwork documented twice, now. The employer he works for gives accumulated sick leave, but it’s something like half a day per month worked without any absences. If you have anything serious come up you have get this paperwork filled out because you can’t accumulate enough sick leave to cover it unless you’ve been there a really long time.

    I, on the other hand, work for a small(ish) company. Less than 50 employees and family owned and operated. We get 5 days sick leave per year. It doesn’t roll over. I’ve worked there four years and have never taken a sick day willy-nilly. The only sick days I’ve taken were planned in advance for a hernia surgery. I was only out three days and I worked from home part of that time. BUT, because of my work ethic if something serious ever did happen to me I wouldn’t have to worry one second about my job and I wouldn’t have to get that ridiculous paperwork filled out. So if I were to fall ill with, say, a heart attack, or the flu that lasted more than a week, or pneumonia, etc., my job wouldn’t be in jeopardy.

    Big corporations do have rules, rules, rules. There’s no taking things on a case by case basis. It’s just there in black and white. If this then that. Period. Not my cup of tea.

    Liked by 1 person

  9. My initial reaction was ‘how dare he use you like that.’ But if I had to support my family, I’d do the same thing. I’d use you too.

    Off topic: I had a colonoscopy (100% clear) and was astonished/blown away by the anesthesia procedure. One moment I’m amiably chatting, the next I’m waking up in another room. It’s like a memory wipe. Amazing the body can be shut down so instantaneously and so thoroughly.

    Liked by 1 person

  10. Five pages? 😦
    Will there be no end to bureaucracy?
    Made me remember a very good client of mine, here in Mexico. He’s American.
    At the end of an hour-long presentation of a huge market research survey which I had concluded with (I thought) a nifty 10 page executive summary, he said: “Perfect Brian, excellent, just send me a one-pager and we’re done.” “A one-pager! You must be joking! You do realize the extent of the survey? Report is 250 slides, I’ve already cut it down to 10 page executive summary!” “Head-office will only look at a one-page summary. You can do it.” Wicked smile. It took me a week to produce the bloody one-pager. I learned something. 🙂 (Maybe I can do – and charge – a seminar to your bureaucrats to teach them?) Be good, Victoire…

    Liked by 1 person

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