A confession: last week I was a little pleased when Rishi Sunak announced that he planned to remove the responsibility of signing fitness-for-work certificates (or sick notes, as they are known) from doctors. It is part of a wider campaign to tackle “sick note culture” and the spiraling cost of long-term benefits.
Of course, there were inevitable accusations that I was being insensitive and “blaming people for being sick.” But I agree with him: there is nothing kind or compassionate about allowing people to sit around at home, day after day, doing nothing with their lives except watching TV and scrolling through social media.
Especially when it comes to mental health, research shows that the stability, structure, and routine people get from work is medicine in itself.
Some of those on sick leave, and many of those on sick pay, don’t want to hear that, of course. But for those of us on the front lines, sick note culture is a daily battle.
It’s not just GPs who are asked to submit them: throughout my career in mental health, I have signed many sick notes, sometimes reluctantly.
“I take signing sick leave notes very seriously because I am aware that they can lead to abuse,” writes Dr. Max.
In fact, I have often faced a real dilemma. I have some patients who I really believe should not work because they are unwell, but when I suggest they be fired, they refuse, saying they are proud of their work.
On the other hand, I see people who seem to think that feeling a little depressed or not enjoying their job means they have the right to stay home on a full salary or have access to benefits.
I think it is fair and noble for a country to support its weakest members. I want pensions and welfare payments to increase; At the moment, they barely allow people to rise above the poverty line. But if we are going to do this, we have to recognize that a proportion of people receiving sick pay or claiming sick pay do not deserve it.
How have we gotten to the point where the welfare state is no longer just a safety net, there to catch you when you’re down on your luck or depressed by illness, but rather a feather-filled mattress to lie on while you play? ? Xbox?
I take signing sick leave notes very seriously as I am aware that they are subject to abuse. But over the years, I have realized how difficult it is to challenge patients. It has the potential to completely ruin the doctor-patient relationship and, even worse, there is a risk of assault or even threats and violence.
While I believe it is my duty to protect the public purse and accurately assess whether, in my opinion, patients are capable of working, I also quite like my face as it is, thank you very much.
I remember seeing a patient when I started working in outpatients who had come in for sick leave. He was in his 40s and had been a postman but, for the past four years, he had been ill on and off due to depression, stress and back problems.
At first he was very pleasant and polite and told me about the two week holiday abroad he had just enjoyed. In fact, life was going well, he told me. But he suddenly became touchy and irritable when I started asking him exactly why he wasn’t at work.
—What does that matter to you? she asked, before I pointed out that, as his new outpatient doctor, the person required to sign the sick certificate was largely my business.
Since his depression and stress were improving, I said, perhaps the best thing for him now would be to return to work; after all, all the research showed how good it would be for him.
I offered to write to his employers asking them to change his duties to avoid heavy lifting. I suspected that the various beach activities I had talked about meant that her back was improving, but I didn’t mention that.
His response was to kick the chair I was sitting in across the room, insult me, and storm out. And who can blame him? Who would want to go back to work when he can live for free?
I later found out that he had visited another doctor after seeing me and she had signed him off sick. Compare this to another patient I recently saw on an outpatient basis. He had a serious, degenerative and life-limiting neurological condition, which meant he could not walk or stand. He was on a cocktail of medications and, to top it all off, he had bipolar disorder and epilepsy. Her medications made her incredibly tired. She was incontinent and had a catheter.
Now, I think it’s fair to say that you would forgive this person for not working. However, I was surprised when he told me that he still worked full time at a supermarket. In fact, he insisted on meeting me early in the morning so he could get to work on time that day.
The company had made adjustments for her so that as her condition worsened, she no longer stacked shelves and instead worked at the checkout in a specially adapted chair and took frequent breaks.
The job wasn’t glamorous, but it was important to her, and when I suggested she fire him, she was offended.
“I don’t want money unless I’ve earned it,” he told me.
Is it really said that anyone on sick leave or sick pay is worse off than this brave woman? I seriously doubt it. If she can get up and go to work and take pride in being able to support herself, why can’t so many others?
The decrease in public bathrooms worries me a lot. It can seriously limit life, especially among older people. Many don’t go far from home or confess to not drinking enough. Adequate hydration is very important.
Orlando is right to let him go
Orlando Bloom states in a podcast that he has had to learn to be less ‘controlling’ in order to have a harmonious relationship with his fiancee, singer Katy Perry, 39. The actor, 47, stated that ‘when you’re in a deeply loving and committed relationship situation, you want to control or possess (the other person)’ and that he constantly had to learn to ‘let go’.
People who feel the need to control every aspect of their lives often have perfectionistic traits. The feeling of not having control can cause a lot of anxiety. But of course it is neither practical nor desirable.
Accepting that you can never truly be in control of your life or your relationship and instead allowing the other person to be themselves, in all their imperfect glory, is one of the most important life lessons a perfectionist can learn.
Orlando Bloom assures in a podcast that he has had to learn to be less ‘controlling’ in order to have a harmonious relationship with his fiancée, the singer Katy Perry, 39 years old
A damning report from the World Health Organization (WHO) says the UK tops the charts when it comes to underage drinking, with one in three 11-year-olds having tried alcohol.
While we tend to think that people from poorer homes are more likely to dabble in alcohol and drugs, in reality it is young people from richer backgrounds who are more likely to dabble.
Charities warn that they “mirror” the behavior of wealthy parents who frequently drink wine.
But alcohol can be enormously harmful to children’s developing bodies. We know that it affects the liver, the brain and the bones, for example. I think it speaks to a broader problem with alcohol in our culture. Deep down, we have a hard time seeing it as the drug it is.
Dr. Max Prescribes…Fall Detection
A smart feature on smartwatches like the Apple Ultra can tell when someone has suffered a fall and alerts people in your emergency contacts. If you detect that they have been immobile for more than a minute, call the emergency services. Great if you need a little tracking, but want something discreet.
A smart feature on smartwatches like the Apple Ultra can tell when someone has suffered a fall and alerts people in your emergency contacts.
