By: K. Jeffrey Miller, DC, DABCO
One aspect of being a doctor that was never mentioned in school, and I have not seen in a journal or text book, is how to write a ‘doctor’s note.’ You know what I mean: Someone tells a patient, “I’ll need a note from your doctor for that,” and bam!—you have another item for your to-do list.
Early in practice the requests for notes were pretty standard—notes for work and school absence being the most commonly requested. As practice continued, the things patients requested notes for became more unusual. For example: A patient who has occasional back pain missed an airline flight and wanted a note saying he missed the flight because of his bad back. This despite the fact that I had not seen him for months and the ticket was nonrefundable.
The Lying Liar and Other Taletellers
Then there was the rebellious teen injured in an auto accident, who began lying down in the back of her high school classroom. When the teacher told her to get up, she said, “My Chiropractor told me I could lay down in class.” This prompted calls from school officials who thought I was crazy, and from parents who actually wanted a note for it. It was all news to me.
Dress codes create note requests. A patient who, in fifteen years never complained of foot trouble, suddenly had unrelenting foot pain when she was told she could no longer wear tennis shoes to work. A note saying she could only wear tennis shoes was her treatment of choice. “I don’t want you to look at my feet, just write me a note,” she insisted.
High fashion for teenage boys these days is wearing the waist of their pants just above their knees, with their boxer shorts showing. When the manager of a fast food restaurant told one young patient to pull his pants up and conform to the company dress code, the kid asked for a note that said he could not wear his pants normally because the pressure of a belt around his waist hurt his back.
Patients frequently buy home health aids and exercise equipment without consulting their doctors. If they don’t like or don’t use the merchandise and have trouble returning it, who do they call? That’s right! Their Chiropractor!
Doctor’s Note Not a Blank Check
Then there are the notes requested by patients who are sure that their insurance company will pay for some item they want, just because I say so. They want notes for gym memberships, hot tubs, chairs, special beds, and a thousand other items. The kicker for me in this category was a fellow who stopped by the office one day and asked to speak with me. He did not want an appointment, evaluation or treatment—just “to talk.”
When we met he asked if I remembered his wife. When he spoke her name I remembered that I had attended grade school with her. I had not seen her for twenty years. He then related that they had recently returned to my state after living in Florida for several years. He had not worked for over a year because of a work-related injury, and his case was still open.
The man wanted a note for an Art Linkletter Contour Chair. He was sure the adjustor in the case would pay for the chair if I gave him a note. Never mind that I was not his doctor and had no knowledge of his condition, Florida workers compensation law, etc. His wife had told him I was a nice guy and I would probably give him a note since she was an old friend. I told him, “If I could write a note and get a Contour Chair, I would have written one for myself a long time ago!”
Note Trading Idea Shot Down
A few days after this what I told him hit me like a ton of bricks. I thought, “Wait a minute, I am a doctor – I can write notes for myself!” This epiphany was followed by a flurry of self-prescribed notes. And wouldn’t you know it; my wife didn’t accept any of them. I ended up having to sit through two chick flicks, watch the kids, visit my mother-in-law—and the big screen television is still on the showroom floor. We won’t even talk about the trip to the mall….
I quickly regrouped and tried another angle. A friend from high school and I sit next to each other in church choir. He is a medical doctor. I told him about my epiphany, the self-prescribed notes and the road blocks I encountered. I then recommended that we trade notes. The women were on to us immediately! I should have known the note he wanted ordering a belly dancer for his Super Bowl party would tip them off. Well, it was worth a try.
Back to the Goofy Requests
I think that from the first encounter with most patients, they are scoping you out for notes. They all eventually want a note for something. Legitimate requests come whenever necessary. Goofy requests usually result from either a well orchestrated plan or desperation. A well orchestrated plan is usually for a hot tub. Desperation is typically a note for missed work the doctor knows nothing about. I’ve discussed the hot tub before, so let us turn our attention to the note for missed work.
A frequent example is the patient who calls me at home on Sunday evening requesting that I come to the office immediately for an emergency. I rush to the office only to find a patient who is healthier than I am. Questioning the patient quickly reveals the true emergency. The patient needs a note for work Monday morning. You see, he missed four days last week due to his back. He feels fine now and doesn’t want care. He just forgot about needing a note, and since he didn’t have time to come in last week when he was lying around doing nothing, I needed to give up my Sunday evening so he could get that note. This has happened several times, but never twice with the same patient. Fees for office calls after hours are not typically covered by insurance. This results in a very expensive work excuse.
Early in practice, when a patient requested a note for something goofy, I would try to explain why it would not work and try to avoid writing the note. This was like spitting in the wind. By the time the patient asks for the note he is convinced it will work. If I balked, two responses were typical. The first would be a story of how Uncle Pete or some guy at work got a vacation home in Florida with a doctor’s note. The second would be about the patient’s previous doctor, “Old Doc So-and-So could write a note. In fact, some of his notes are in the Smithsonian, next to the envelope Lincoln wrote the Gettysburg address on.” In other words, the patient attempts to draw a line in the sand.
My Foolproof Plan
Once I realized this I developed a plan. The first part of the plan was to formulate standardized notes, one for the most common requests and one for borderline items. My staff was instructed to check the appropriate category and stamp my name on the note. The second part of the plan was to become well versed in writing notes and letters that contained plenty of words but actually said nothing. Notes that acknowledge both parties, mention dates in question, discuss pros and cons, but never really commit to an opinion. Some I’m sure if published, would prompt the awarding of honorary law degrees. They look official and everyone is happy.
I must admit that it is not always the patients who demand notes for goofy reasons. Employers, teachers, coaches, and insurance carriers are also subject to this phenomenon. One of my employees once returned to her home state for the funeral of a dear family friend who had been like an uncle to her. Her husband’s employer demanded a note from the funeral director stating that he had attended a funeral and who was buried. Her husband was in the middle of his fifth year of perfect attendance when this occurred. It wasn’t like he had questionable attendance and was claiming to have lost his third grandmother that year. Still, he had to have a note.
My final thought: Go ahead and write yourself a note. Make it a good note, but be reasonable. Maybe your spouse or loved one will accept it. And, as for the patients, have some patience.
About the Author
Dr. K. Jeffrey Miller is a Chiropractic orthopedist, seminar speaker, and freelance writer from Shelbyville, KY.