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.
secretwave101 
This is not a very popular thing to say but I am so tired of women pulling the pregnancy card to get out of work. I mean, I know that there are times when it’s warranted. But there are several women pregnant at the hospital where I work and a few of them are using their pregnancy maladies as an excuse to make everyone else do their work. That, or they attempt to get work restrictions from their OB (like you mention in your post.) Women have been having babies forever…since when is pregnancy a sickness? Suck it up, you have a baby growing inside of you; it’s not gonna be all punch and cookies like you imagined for 40 weeks.
I don’t know if I’m insensitive or if, as the single girl sans kids who is working her butt off (full-time work, full-time biomedical sciences student) I just get a little bitter…
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I’m sorry, but I think you’re very wrong to equate liberal with “no response to laziness.” I’m very liberal, but not with the work notes! “Suck it up” or “Work on your pain coping mechanisms” is a perfectly good liberal reply to someone who is trying to scam you. “Liberal” does not mean “willingness to be complicit in fraud.” While in my more cynical moments I sometimes think that “conservative” is synonymous with “heartless,” the opposite of heartless is not “dumb.”
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The work-release process is inherently communistic. People are trying to get out of work while still getting paid.
Strict capitalists, by contrast, don’t take money from one group to give to anyone else, which then makes the reason behind why someone can’t work irrelevant. This is a perfect system if no misfortune ever befell anyone, because lazy people would be the only ones out of a job. This is a terrible system when something really goes wrong.
So, a weird part of our job as doctors is to be fundamentally judgmental about the complaint, pondering the “merits” of the case. This is because laziness is so destructive to a communist system. We bandy about terms like “fraud” to make it sound really bad if they’re faking, because if they ARE, and enough of them fake it at the same time, the system collapses.
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Capitalism incentivises production in two instances: 1. when people get compensated for working hard and 2. when people don’t have a choice but to work in order to survive. Guess which method lowers costs and increases profits. It’s not hard to realize why the system isn’t working. Why work when the only guy getting richer is my boss?
Productivity keeps rising in the US. Working class wages keep declining relative to the rich. Socialism? I don’t think so.
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The doctors making comments calling people that are hurt lazy and women that are pregnant lazy don’t belong or have been working too long in a profession in which by nature, should require personality traits like COMPASSION & UNDERSTANDING. Apparently something none of you have ever heard of, You sound like the spoiled heartless ones, complaining about the fact that you are in a great profession THAT YOU CHOSE! and obviously have a way to pay for, whether it be MOMMY or DADDY or some inheritance or trust fund, or even a nifty little essay, that got you the funds for schooling for your job! Did you really choose it for the humanity or did you choose it because you get a fat paycheck for making your own schedules, taking patients at whatever time you feel like, and taking 2 and 3 hour lunches just cuz you have a meeting!! Gosh!! WE SHOULD ALL BE DAMNED TO SUCH A FATE AS TERRIBLE AS DOCTORS!!! You poor things! complaining about working 80 hours a week, WAKE UP!! YOU CHOSE IT!! STOP WHINING!! If you Doctors are really that apathetic to problems of people in the real world that means you are in THE WRONG PROFESSION!! Its because of these attitudes we have so many on the job injuries, people with SICK insurance instead of HEALTH insurance. Tune into REAL AMERICA people!! Most of us don’t have it as good as you do, YES we work with the entirety of our bodies, YES we get hurt, and YES we have REAL ailments because most of us either don’t have, or have CRAP insurance that employs APATHETIC ASSHOLES LIKE YOU ALL!!!, who don’t listen and don’t do the proper testing or deductive reasoning to figure out our problems!! WHICH IS WHAT YOU GET PAID TO DO!!!!! LIVE IN THE REAL WORLD FOR A WEEK AND QUIT BEING WHINING SPOILED LITTLE WOOSES!!
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i just close my eyes and give’em the work note
most of the time as long as they want
why?
cuz it doesn’t affect me, really
i dont care
i dont want to fight this anymore
same goes for those
diabled parking spots, i give it to anyone who requests them
i know they are lying but i still give it to ’em
cuz i am tired of fighting this
an FP
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You know I really want your professional life to fail miserably. You do not belong in it.
First off, your working 80 hrs a week. Why do you residences work such stupid and insane work schedules? I hear of this and I sure as hell do not want some person who has been on the job for an insane amount of hours to be dealing with anything medically to do with me.
Pilots have a maximum amount of hours that they can be on duty for one 24 hour period, know what that is. 8hrs. That’s right the good old and still insane 8hr work day. Why is it that people who are dealing with something far more sensitive than a sophisticated aircraft (the human body) are being made to work their bodies to the brink of failure while performing their duties.
Don’t whine to me about the 80hrs stuff. Your brain should have told you that this is beyond wrong, it is criminal, and you should have taken a stand, along with your work partners.
Perhaps more people would go into your profession if the residency stupidity went the way of the dodo. I know I wrote off the idea when I saw and heard of how people were treated in your profession.
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