NHS=Negligent Health Service

[heeeed]

How do they know its a lie if they don't investigate? When you're a potential accomplice in what is fraud then you have a requirement for due diligence.

As an engineer I couldn't sign off a report saying something was x or y if I hadn't investigated that fact. I couldn't sign off another colleagues work if I hadn't read it and checked calculations or references.

"I'm too busy" wouldn't stand for anything.

Most of the time there is no way to know for certain. If someone says they have back pain, you can’t test to prove they’re lying. I would assess for the sort of back pain that needs eg urgent scanning and then give advice on self management or refer into a service to manage their back pain. If they say it gives them too much pain to work then they can have a sick note. If they say they are too stressed to work then there is not really an objective test to say yes or no. I would assess them at face value and work through how they might improve their mental health to point of being able to get back to work whether that be self help, talking therapies, medication or a combination of all 3. Whilst they work through those they can have a sick note if they state they can't work.

The GP role is to help them and being their advocate is part of that role. A sick note essentially is simply saying they they have sought medical advice and they don't feel currently able to work. It's outdated and pointless in most cases and is neither designed for nor provides what you probably think it does. If it's for benefit purposes then there are work capability assessments and other systems to try and assess someone's appropriateness for ongoing sick notes. If it's the private sector then they should arrange assessment by an occupational health service to assess, and if they are felt to be lead swinging then the occupational health teams assessment would be used in any potential disciplinary systems. A GP is neither trained in nor indemnified (unless they have also done the relevant qualifications) for that kind of work and so shouldn't do it. It also would take an awful lot longer than a 10 minute appointment that was also being used to actually provide care for them. The nearest to commenting on the validity of their need or policing it would be to write a comment recommending an employer arrange an occupational health assessment.

Employers on the whole know who is taking the **** either from frequency or length of notes (and I say this as an employer who has to deal with the other side of things also) but it's their duty to arrange appropriate assessment there not mine. You also open up the issues around disability act and discrimination within that law which again is their issue not mine.

You can't compare these to a report you do as an engineer, as you are both trained, provided time for and appropriately paid to sign off such a report. If you aren't then you should rightly refuse or look for a job elsewhere or even consider whistle blowing if such practice was endemic in the system

tldr, a sick note doesn't do what you think it does

 

[Dis86]

Most of the time there is no way to know for certain. If someone says they have back pain, you can’t test to prove they’re lying. I would assess for the sort of back pain that needs eg urgent scanning and then give advice on self management or refer into a service to manage their back pain. If they say it gives them too much pain to work then they can have a sick note. If they say they are too stressed to work then there is not really an objective test to say yes or no. I would assess them at face value and work through how they might improve their mental health to point of being able to get back to work whether that be self help, talking therapies, medication or a combination of all 3. Whilst they work through those they can have a sick note if they state they can't work.

The GP role is to help them and being their advocate is part of that role. A sick note essentially is simply saying they they have sought medical advice and they don't feel currently able to work. It's outdated and pointless in most cases and is neither designed for nor provides what you probably think it does. If it's for benefit purposes then there are work capability assessments and other systems to try and assess someone's appropriateness for ongoing sick notes. If it's the private sector then they should arrange assessment by an occupational health service to assess, and if they are felt to be lead swinging then the occupational health teams assessment would be used in any potential disciplinary systems. A GP is neither trained in nor indemnified (unless they have also done the relevant qualifications) for that kind of work and so shouldn't do it. It also would take an awful lot longer than a 10 minute appointment that was also being used to actually provide care for them. The nearest to commenting on the validity of their need or policing it would be to write a comment recommending an employer arrange an occupational health assessment.

Employers on the whole know who is taking the **** either from frequency or length of notes (and I say this as an employer who has to deal with the other side of things also) but it's their duty to arrange appropriate assessment there not mine. You also open up the issues around disability act and discrimination within that law which again is their issue not mine.

You can't compare these to a report you do as an engineer, as you are both trained, provided time for and appropriately paid to sign off such a report. If you aren't then you should rightly refuse or look for a job elsewhere or even consider whistle blowing if such practice was endemic in the system

tldr, a sick note doesn't do what you think it does

Every single sick note I've ever seen is a signed declaration that x or y is unfit for work due to z. If said GP is not actually carrying out an assessment then how can they possibly make that declaration?

They do not say "x has said their head hurts so they may have y which would render them unfit for work".

The notes are a clear statement of "facts" thus adequate assessment should be carried out before they are signed off. I agree you could rarely do it in 10 minutes but that doesn't mean you should therefore sign it because you only have 10 minutes.

We absolutely do involve occupational health however it is a long process and where claims of things such as stress are involved it can be difficult. Particularly where a medical professional has provided a signed statement declaring with certainty that said person has stress. Because said person told them so. And without questioning they believed it.

 

[fez]

Reason why there is a staff shortage in the NHS is because the sick pay is too generous 6 months on full pay is why there is so many staff on sick with "stress" put them all on statutory sick pay and you will solve the staffing problems overnight.

Thats not even slightly true. Yes they have a small issue with **** staff but they have a far bigger issue with people leaving the profession and their positions not being filled. With an increasingly elderly population who think its their right to top tier health care as they abuse their bodies their entire lives but eating and drinking too much and doing **** all exercise.

They have an issue with the job not being attractive to many people due to the **** treatment they get from patients, the average pay and hard work. Watching colleagues die during COVID because people were too selfish to take basic precautions.

There are over 130,000 vacancies in the NHS at the moment. I would be amazed if even 1/10th of that is people taking the ****.

 

[Dis86]

Thats not even slightly true. Yes they have a small issue with **** staff but they have a far bigger issue with people leaving the profession and their positions not being filled. With an increasingly elderly population who think its their right to top tier health care as they abuse their bodies their entire lives but eating and drinking too much and doing **** all exercise.

They have an issue with the job not being attractive to many people due to the **** treatment they get from patients, the average pay and hard work. Watching colleagues die during COVID because people were too selfish to take basic precautions.

There are over 130,000 vacancies in the NHS at the moment. I would be amazed if even 1/10th of that is people taking the ****.

As I've highlighted on here before, unfortunately the government/NHS are making part of the rod for their own backs. They are simply not providing the facilities, funding and training to recruit people for those positions. It's either insanity or intentional.

 

[fez]

As I've highlighted on here before, unfortunately the government/NHS are making part of the rod for their own backs. They are simply not providing the facilities, funding and training to recruit people for those positions. It's either insanity or intentional.

Its a tricky one because fundamentally the NHS needs a massive funding increase...which we currently cannot afford. I would wager that purely on staffing alone, if they gave staff a 10% raise and filled all the gaps in staffing they would raise the staffing costs by 20%+. Thats huge in a business the size of the NHS.

It does need reform though. And we need to start taking peoples health seriously from a preventative perspective. I'm sick of people saying that that healthy food is expensive or that they can't cook or that they have a million reasons why they are overweight other than their own laziness. We could fund the NHS to the tune of twice what it is currently and we would be in a similar situation in 10 years time. The current trajectory of people living longer but on a cocktail of drugs and borderline living at the doctors cannot continue.

 

[Dis86]

Its a tricky one because fundamentally the NHS needs a massive funding increase...which we currently cannot afford. I would wager that purely on staffing alone, if they gave staff a 10% raise and filled all the gaps in staffing they would raise the staffing costs by 20%+. Thats huge in a business the size of the NHS.

It does need reform though. And we need to start taking peoples health seriously from a preventative perspective. I'm sick of people saying that that healthy food is expensive or that they can't cook or that they have a million reasons why they are overweight other than their own laziness. We could fund the NHS to the tune of twice what it is currently and we would be in a similar situation in 10 years time. The current trajectory of people living longer but on a cocktail of drugs and borderline living at the doctors cannot continue.

Absolutely. What we also need is people to start taking more accountability for their own health. It would reduce the strain massively, particularly on A and E departments. In turn freeing up resource further down the line.
Unfortunately we have massive sociological issues in this country particularly with alcohol and excessive consumption of calories. On the plus side we're getting on top of smoking but that's too little and too late.

 

[SexyGreyFox]

Shocking. And you're basically right opposite the entrance to Trent too.

and I've been to cardiac Rehab to find Clinicians to sign reports.
In fact Goodie might be one.

 

[heeeed]

Every single sick note I've ever seen is a signed declaration that x or y is unfit for work due to z. If said GP is not actually carrying out an assessment then how can they possibly make that declaration?

They do not say "x has said their head hurts so they may have y which would render them unfit for work".

The notes are a clear statement of "facts" thus adequate assessment should be carried out before they are signed off. I agree you could rarely do it in 10 minutes but that doesn't mean you should therefore sign it because you only have 10 minutes.

We absolutely do involve occupational health however it is a long process and where claims of things such as stress are involved it can be difficult. Particularly where a medical professional has provided a signed statement declaring with certainty that said person has stress. Because said person told them so. And without questioning they believed it.

They have to have something put in as a reason and that will have been the clinical decision as to what their diagnosis is and that is the factual statement that the doctor believes this to be the case. The time needed etc is very variable as patients are not the same, other comorbidities, personal dynamics etc will be different. None of this can be conveyed in such a short form. As I said a sick note isn’t intended to do what you think it is.

Unfortunately medicine often doesn’t deal with absolute, indisputable facts which would frustrate an engineer I accept, but that is the reality

 

[Dis86]

They have to have something put in as a reason and that will have been the clinical decision as to what their diagnosis is and that is the factual statement that the doctor believes this to be the case. The time needed etc is very variable as patients are not the same, other comorbidities, personal dynamics etc will be different. None of this can be conveyed in such a short form. As I said a sick note isn’t intended to do what you think it is.

Unfortunately medicine often doesn’t deal with absolute, indisputable facts which would frustrate an engineer I accept, but that is the reality

Agreed they have to have something to put in as a reason but that's where language is important. They could state it is believed, suspected, presumed. Yet this is a stated fact that, by your own admission, is often stated without adequate investigation.

What is your belief/understanding/knowledge on the purpose of a sick note? Mine is that they are a signed statement by a suitably trained and qualified medical professional as to the reason why an individual is not fit to work. This is based upon every single note I've ever seen stating X is not fit for work due to Y.

 

[Minstadave]

Agreed they have to have something to put in as a reason but that's where language is important. They could state it is believed, suspected, presumed. Yet this is a stated fact that, by your own admission, is often stated without adequate investigation.

What is your belief/understanding/knowledge on the purpose of a sick note? Mine is that they are a signed statement by a suitably trained and qualified medical professional as to the reason why an individual is not fit to work. This is based upon every single note I've ever seen stating X is not fit for work due to Y.

There is no investigation for most conditions that people are signed off for - stress/chronic pain/fatigue, so I don't know what you're expecting the GP to do other than listen to their patient and act accordingly.

Plus there is the conflicting interest of being the patients advocate vs deciding whether or not they're fit to work when they're telling you they are not.

 

[Dis86]

There is no investigation for most conditions that people are signed off for - stress/chronic pain/fatigue.

Yet these are all things that can be demonstrated or determined to some extent through questioning. Again however, if there is no investigation carried out then it should not be stated with certainty that that is what the person is suffering from. It's a belief or assumption.

Nice anecdotal one for you but some time ago when I was suffering from an eye problem which can be caused by stress (mine was actually triggered although not directly caused by an unfortunate sports injury!) my GP basically offered to write me a sick-note for stress with absolutely no prompt. Mentally I was absolutely fine, physically I had some vision distortion due to fluid build up behind my retina.

 

[Minstadave]

Yet these are all things that can be demonstrated or determined to some extent through questioning.

This is what the GP does and then issues a sick note.

Again however, if there is no investigation carried out then it should not be stated with certainty that that is what the person is suffering from. It's a belief or assumption.

You don't like the terminology of a sick note. We get it. The reality is is there are rarely hard facts in medicine and a sick note is no different. It's not a engineer signing off a machine (which I expect isn't always correct either).

 

[Mr Badger]

You don't like that people aren't machines. We get it. The reality is is there are rarely hard facts in medicine.

^FTFY

 

[Dis86]

This is what the GP does and then issues a sick note.



You don't like the terminology of a sick note. We get it. The reality is is there are rarely hard facts in medicine.

No, that isn't by my experience and that of my staff. There is little to no questioning taking place. I have a gent on long-term sick (who I do know is actually ill) who literally just calls his GP and asks for it to be extended. He could have recovered some time ago and they are carrying out no diagnosis at all.

And terminology is vital, particularly if things go down a legal route. I'm not disputing their are rarely hard facts but there are certainly falsehoods.

 

[Mr Badger]

Well that was weird. When I do a quick FTFY I don't expect you to actually go back and edit your original post!

 

[Minstadave]

No, that isn't by my experience and that of my staff. There is little to no questioning taking place. I have a gent on long-term sick (who I do know is actually ill) who literally just calls his GP and asks for it to be extended. He could have recovered some time ago and they are carrying out no diagnosis at all.

And terminology is vital, particularly if things go down a legal route. I'm not disputing their are rarely hard facts but there are certainly falsehoods.

There is some truth is the idea that some GPs will just sign people off without any real effort. Some will be lazy, some will understand the patient is the person best placed to judge when they're ready, others will be rushing as they're 2 hours behind in their session and others will make a wholehearted effort to do a thorough assessment - welcome to medicine/humans.

 

[Minstadave]

Well that was weird. When I do a quick FTFY I don't expect you to actually go back and edit your original post!

Sorry I do that all the time.

 

[heeeed]

The questioning for those is how you come to the diagnosis or working diagnosis yes, but there is not some perfect objective question that defines it.

“Do you feel stressed?” - “yes”

well then if the other symptoms were also in keeping with a diagnosis of stress then that is what they likely have or would be a suitable working diagnosis. Uncertainty is something a doctor gets very comfortable with in their daily practice, but it isn’t common in many other fields so I acknowledge the difficulty that can give you

I’ve no idea about when you were seen as I wasn’t there. I assume that they thought you were stressed and that if your symptoms could be caused by stress that would be their working diagnosis.

 

[Dis86]

There is some truth is the idea that some GPs will just sign people off without any real effort. Some will be lazy, some will understand the patient is the person best placed to judge when they're ready, others will be rushing as they're 2 hours behind in their session and others will make a wholehearted effort to do a thorough assessment - welcome to medicine/humans.

Yes and that's the point. Given the responsibility of their position they shouldn't be doing that. To be blunt it's one of the things that isn't helping the NHS right now, just look at staff sickness levels and think how many of those people are quite frankly milking a generous sickness system. I have the same problem, my company has a very generous sickness package which is there for those who, unfortunately, truly need it. It gets heavily abused by some individuals however.

 

[Dis86]

The questioning for those is how you come to the diagnosis or working diagnosis yes, but there is not some perfect objective question that defines it.

“Do you feel stressed?” - “yes”

well then if the other symptoms were also in keeping with a diagnosis of stress then that is what they likely have or would be a suitable working diagnosis. Uncertainty is something a doctor gets very comfortable with in their daily practice, but it isn’t common in many other fields so I acknowledge the difficulty that can give you

I’ve no idea about when you were seen as I wasn’t there. I assume that they thought you were stressed and that if your symptoms could be caused by stress that would be their working diagnosis.

Central serous retinopathy. First thing I mentioned was I'd fallen when bouldering and banged my noggin on the way down, that side making impact. Booked me an appointment at the eye hospital and offered to write me a sick-note for stress.