I’ve recently been seeing patients who are requesting “work restrictions”. This is a big part of primary care medicine. The patient tells their employer that they have been injured on the job – emotionally or physically – and the doctor determines how much the patient is capable of working, if at all.
Much of the time, I see people with back pain or joint problems and usually they come from manual labor jobs that are hard on your body. Still, I would say that only 50% of the time I’m confident that the patient isn’t just bilking the system because they’re lazy or bored, they just don’t like working or they want narcotics. I’ve had patients ask for some pretty whiny things: “I can mop the floors, but I can’t clean the toilets. Yeah, you see I need someone to go with me and clean the toilets, they’re hard on my back. Oh, and I can only work on Tue and Wed afternoons. Can you write that letter for me, doc?”
I’m thinking, “To ask for something that dumb, you must have broken both of your arms, or perhaps you can’t operate your legs, right? Pretty valiant of you, trying to work without the use of your arms and legs.”
Alas, no. The reason for the needed letter is frequently something like: “Depression. Maaajor depression. I’ll probably get suicidal, too. Oh, and I’m pregnant. It’s hard to work when I’m pregnant.”
Really? That’s it? You’re bummed out with your job? I’ve got to say, if you want to find someone who might have a compassionate ear in this area, don’t go to a resident who works 80 hours a week. Find a doc who’s ready to retire and doesn’t care one way or the other. For me, I can’t tell you how many times I think I’m going to crack under the pressure of our training, or how many hours we do that seem too much. This is not to say I’m in the same league as pregnant patients. I’ve never been pregnant, but I know it’s a tough road and I respect the millions of women who keep their lives together while also carrying a growing child.
This is why I try to give every person an honest chance to convince me that they need work restriction and/or disability pay. My goal is to truly listen to their stories, and do at least a little research on their past medical history. Some people are for real and truly need the help.
But more and more often, I’ve been turning them down flat. My message: Buck up, camper, workin’ sucks. That’s why you’re paid to do it.
I worry that I’ll regret my decision any time I refuse to get people out of work. Maybe I’m wrong. Maybe they really will get suicidal and something tragic will happen that I could have prevented. But I can’t shake the idea that if I go against my impression, I’m getting involved with a racket that does no good for anyone.
The problem with conservative political theory is that it has no good answer for misfortune. Something goes wrong in a truly conservative system, and you’re dead. However, liberal political theory has an Achilles heel as well. In a truly liberal system, there is no answer for laziness. If people don’t want to work but devise a reasonable story about the misfortune in their lives, a socialist system can do nothing but cave in and give them money. I suppose in a truly moral society, both systems work equally well, since the fortunate would take in the truly unfortunate in a conservative society and nobody would bilk the system in a liberal socialist society.
America began as a decidedly capitalist system, but it is becoming more socialist by the day. We could probably create a virtual utopia if we were headed in this direction because so many of us wanted to work our bodies to exhaustion for the betterment of our commune of 300 million people. But I don’t think this is why we’re becoming communists. We’re becoming a commune because it’s the best system for laziness. More and more people want to pour their energy into complaining about their pain and anxiety and misery – effectively consigning themselves to a publicly subsidized life of lesiure, pleasure and often a steady stream of narcotic meds – rather than drag themselves out of bed every day and put their hand to the plow. This is a recipe for societal disaster.
In a socialist system, nobody except the terminally-ill and the demented elderly should live without being expected to contribute hard work to the greater good. Ironically, hard labor is probably the best protection against obesity, heart disease, dementia and stroke…all the scourges of our modern, lazy society. Social security and welfare are good ideas. But they assume that nobody in society is lazy. They assume that nobody would take advantage of the system. For this reason, the system is destined to fail.