Saturday, February 26, 2011

The social responsibilities of family physicians - the case of Wisconsin family doctors

Earlier this week, 4 family physicians donned in white coats and stethoscopes were observed handing out sick notes to teachers and other public employees who were rallying outside Wisconsin's state capitol. At this point, the protestors have been rallying for almost 2 weeks straight. These 4 doctors were handing out sick notes to any one who needed them so that they could call in sick while continuing to protest.

At stake for teachers and other public employees was the benefits, wages and the right to protest as the Wisconsin state government tried to rein in their budget and limit public employees' labor rights.

At stake for doctors...?

Multiple media sources labeled the sick notes as fraud. They claimed that the doctors were giving these notes when:
  • the doctors were not the regular providers for the protestors
  • the doctors were not taking histories or examining before handing out the sick notes
  • the protestors were not actually sick!

One way to approach this is to debate what constitutes as "fraud." Another way, the one I am going to take, is looking at what social and policy responsibilities of a physician. As a future family physician, I believe that we need to look at a broader definition of health and its improvement. If workers' rights are taken away and wages are decreased, do these affect their psychological health... often resulting in physical health implications? I would argue that physicians should not stick to the medical issues to the isolation of political issues. When we do so, we risk leaving the determination of policies and laws to others who may not have the improvement of health in their interests. I personally think physicians stand to gain a lot when we bring our personal narratives about our medical experiences into the realm of politics and policy making. Policy makers, and the general public shy away from statistics and scientific studies and are much more convinced and drawn to personal stories.

However, while I agree that physicians need to be active in policy and politics, I question the mode in which these Wisconsin physicians (all affiliated with UW Madison's family medicine department) engaged in policy making. While physicians need to be engaged citizenry, the professional role (writing sick notes) should not be mixed directly with the advocacy role.

Another thought I had: what is a sick note? Why do doctors write sick notes? In America (and in many countries), patients choose their physicians. I haven't seen statistics on this, but I would say only rarely does a physician refuse to write a sick note when requested by a patient. If a physician did refuse, the patient only need go to another doctor. So, what does the "sick note," so often requested by employers, really signify, if anything? Why are doctors even involved in this play between between employers and their employees?

Thoughts? On either sick notes or physicians' social and advocacy roles?

Media coverage of Wisconsin doctors writing sick notes for protestors:


  1. I also agree that physicians should be leaders within our communities. From a social/historical/anthropological perspective, healers such as shamans in South America, to priests in ancient Egypt, or the physicians of imperial courts in Asia have either lead their tribes or been consulted by their sovereign rulers. Today's American physicians must continue this ancient tradition by actively participating in the democratic system.

    Secondly, what is good for the patient is usually good for the physician. If the Wisconsin stand along the sidelines and watch their patients' benefits and salaries get cut, then they should expect a trickle down affect. However, they may help both parties and mention that "everything in moderation" is wise advice. And that may go for both health management and governance.

  2. You know, here's a thought. When we miss work to go lobby, serve on volunteer boards, even go do TAR WARS, we do not get paid. The purpose of these sick notes is so the teacher, who signed a contract to work X-nmber of days each year, can still collect full pay while skipping work to do something they feel is more important. If they skip work without the sick note, they would be like the rest of us who pay a price for activism. See the difference?

  3. Nice piece. This is a thorny issue and it's grea to see you taking on this type of challenge

    Larry Bauer