Confessions of a GP

• It is early November and a woman wants to be signed off on sick leave because Christmas is coming and her mother died at this time several years ago. Her cat has cancer and she thinks that she won’t be able to cope at work until January. She doesn’t have any symptoms of clinical depression.

• A man was sacked from his job because of heavy daytime drinking and being drunk at work. He feels that he is unable to work now because of his alcohol dependence. He is not willing to be referred to an alcohol counsellor or a rehab programme.

• A 25-year-old man was born with severely deformed arms and, at the age of 18, was signed off as disabled. A year ago he got a job at a supermarket but was sacked after being caught giving his friends unauthorised discounts. Now he wants to go back on to disability living allowance. He doesn’t have any new illnesses or disabilities.

• A 45-year-old woman who is extremely overweight and gets very short of breath because of her heavy smoking and large size. She did have a job in a supermarket but because it is on top of a hill she can’t get there. She is making no effort to stop smoking or to lose weight.

What do you think of this lot? Would you sign them off? As you can see, the decisions I make on sick notes are often less related to my medical knowledge and more to do with my general sympathies towards a particular person on that particular day. When I hand out a sick note, I am basically signing that person a cheque made up of taxpayers’ money.

Am I any more qualified to make these decisions than someone with no medical training? These patients are people doctors potentially know quite well and sometimes it can be hard to say no to them. It is also very difficult to prove or disprove what they are telling us. For example, I have a patient who tells me that she can’t work because she has a panic attack every time she leaves her house. Perhaps she does. Perhaps she doesn’t. I am not going to sit outside her house and follow her into town taking photos of her having a great time in a crowded shopping centre. Physical symptoms are equally difficult to disprove. If a patient tells me that he has back pain, who am I to disbelieve him. He may have multiple normal scans, X-rays and examinations, but if he tells me that his back hurts and he can’t work, do I have the right to call him a liar? We are taught to listen to our patients and try to do our best for them. It is very difficult all of a sudden to start distrusting them and try to catch them out.

Although I do have patients trying to pull the wool over my eyes, most of my patients who are requesting a sick note or claiming disability payments are doing so genuinely. They have an illness or disability and need some medical documentation to verify this so that they can get some money to live on. Most people do actually want to return to work as soon as possible. Whatever our job, we generally moan about it and look forward to having some time off for a few weeks a year, but ultimately most of us want to be employed. It is partly how we define ourselves and there is a social stigma attached to not working. From a personal perspective, my job is rewarding and I feel valued. If I take time off, then I feel I am letting down my colleagues and patients. I do sometimes wonder whether my work ethic would be so strong if I had a less appealing job. If I toiled stacking shelves overnight in a supermarket for the minimum wage, I can imagine that the temptation for ‘pulling a sickie’ would be pretty strong. Perhaps I could even hoodwink my GP into writing me off work completely. I could then get close to the same pittance sitting at home on disability payments.

Most GPs hate giving out sick notes and filling in disability claim forms. They take up time and valuable appointment slots. I heard of one GP in a particularly deprived part of Wales who completely gave up trying to assess his patients’ ability to work. He used to go into his crowded waiting room each morning and ask everyone who was in for a sick note to put up their hand. Without asking any of them a single question, he would then go round and dish out a sick note to each one of them and therefore clear half of his waiting room. This allowed him to spend his morning as a doctor rather than as a clerk for the Benefits Agency.