​I felt I had to sign sick notes even when patients were comfortable working. Some seemed more interested in keeping their benefits, DR writes. MARTIN SCURR

When I first started working as a GP, one of the most difficult daily tasks was signing sick notes.

I had no training in this, and the problem was not just signing the form and making the diagnosis, but making a judgment about how much time off work the patient needed before he or she would be able to work again. are.

This was not so much of a problem if a patient had had a clear and obvious problem, such as pneumonia or after a heart attack, where there is a fairly standard recovery period of several weeks or months.

The trouble was that the patient didn’t feel like going, wasn’t desperate to get back to work – or, it should be said, seemed inclined to continue taking benefits (more on that below).

These patients would be in a condition that wouldn’t stop most other people, and as often as not, you would sense that there were other, unspoken problems.

All this was even harder when the problem was poor mental health.

As physicians, we have no diagnostic tests, let alone criteria, to assess the patient’s degree of incapacity or suffering – or how long that may last.

The only guideline is what the patient says he feels. And then add to that the fact that as a primary care physician you are on the patient’s side, being their advocate, concerned about them, and hoping, even fighting, to help them regain good health and function.

So it’s hard to question what they say they feel, to say no – even when you know they could actually manage to return to work.

For this reason, I can see how we have ended up where we are today, with the staggering increase in the number of people out of work due to long-term illness, at a record high of 2.8 million people, while doctors like me may have just drawn on the dotted line.

Some outside the profession might say this is a box-ticking culture. Far from being about doctors putting the patient first, that means trusting them rather than judging them.

So the proposed changes to sick notes outlined by the government last week, which would no longer see doctors tasked with issuing them, are welcome.

This will now be a task for specialist work and healthcare professionals who will not have to face the unpleasant challenge of judging whether people with an anxiety or mood disorder – and without a formal diagnosis – are able to work, without emotions being involved.

But to return to the other issue, known to the professionals as ‘plumbus oscillans’, taking charge.

A few years ago, on a short ski vacation, I was riding a chairlift and sat next to a man younger than me, possibly in his mid-fifties, with one wrist in a cast.

I commented that I thought it was quite heroic to be going up the mountain with a broken wrist, even though things were getting better, and he responded by telling me that he had had a hip replacement six weeks earlier.

I was surprised that he was thinking about skiing.

But he said he was doing well, and wanted to make the most of his time off, as he had two months’ sick leave and was determined to enjoy the break (pardon the pun).

Couldn’t he be back at his workplace?

I thought so too. But if I protested to him, I would be seen as a killjoy – and this once again underlines the fact that patients should see us as doctors as people on their side and not as their discipline.

My relationships with my patients are cherished – and often hard-won. I have no desire to jeopardize the warmth and confidence in me as their doctor and counselor that would come from having to watch over the public finances.

It’s hard enough having to ration our medical exams and prescription costs without having to think about the country’s social security law.

I prefer to leave the supervision of this to other experts.