Pressured GPs have been unhappy for years with the time they have to devote
to signing people off sick from work. Dr Phil Peverley, a GP in Sunderland,
gives a fascinating insight into the frustrations doctors often face when
issuing patients with sick notes.
I am disgusted with myself. I am weak and pathetic. There was no way, just
no way that that last bloke was going to get a sick note out of me this week.
Four weeks ago, he fell over (at work… on a wet floor… praise be to God for
manna from heaven!) and sustained an ankle injury so tiny that I initially
examined the wrong leg. The pain and discomfort he suffered must have lasted a
couple of minutes, at most, and yet here he is a month later describing
persistent pain, swelling (‘Where?’ I demanded. ‘It comes later in the day,’ he
explained gently, as if to an idiot), sleeplessness, weakness, unsteadiness on
his feet, nightmares, anxiety, and an irrational and probably permanent fear of
damp floor tiles.
I hate this. I hate being forced to take part in this amoral charade, where
dishonest consultation follows dishonest consultation; where the patient lies
through his teeth, and I know it, and he knows I know it. Yet there seems no
way out without a direct accusation of lying.
My patient wants treatment. Drugs. Preferably of more than one kind. He
wants to be examined several times, and have his symptoms documented. He wants
an X-ray or a scan, (‘Better order both doctor. Can’t be too careful’) and,
very importantly, he wants certification of his disability. But more than
anything he wants a referral. Physiotherapy would be good, but an orthopaedic
referral best of all.
‘Look at me!’ he wants to shout. ‘My injury was so bad I had to see a
specialist! My life is ruined! Pay me!’
Neither of us has mentioned it yet, but we both know that it will only be a
matter of days before the letter from Rentboye & Hore (Solicitors) lands on
my desk. ‘We act for our client following the incident of the 23rd,’ they will
write – the slippery, shameless chancers. ‘We can confirm that no action is
planned against you or your practice. However, send us a report, and copies of
all his records from the year dot, you never know your luck.’
I cracked, hating myself, and gave him another sick note. ‘This will be the
last, mind! You’ll be fine by next Monday.’ He smiled a twisted sad smile. ‘I
hope so, doctor. How I wish I could get back to work!’ He got up and left, and
I performed my usual Roger Neighbour-style housekeeping and de-stressing
technique. I leapt to my feet, poised with arms outstretched like a conductor
for a few pregnant seconds, then launched into a manic flurry of obscene
gestures and facial contortions. ‘Tourettes Shadow Boxing’, I call it. I was
half way through a more than usually energetic performance, and was standing on
one leg miming a fart in the direction of the patient’s chair, when the door
burst open and my patient leapt back into the room.
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‘Sorry to interrupt, doctor. I forgot my walking stick.’ He grabbed it
quickly and then he was gone.
Slowly lowering my leg to the ground, I saw him walk past my window at a
rate that would have done credit to one of those ridiculous Olympic walkers.
There was no trace of a limp, and his walking stick was touching the ground on
only every seventh or eighth step.
