At demonstrations supporting public sector unions in Madison, Wisconsin, doctors are writing fake medical excuse notes for participants. This raises medical, legal and moral issues pertaining to the proper role of physicians.
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In many states like Wisconsin, Ohio, New Jersey and Florida, Republican governors are facing overwhelming deficits. As a result, they are challenging public sector unions, which they see as responsible in large part for high state expenditures.
In Wisconsin, Governor Scott Walker, facing a $137 million budget deficit has proposed eliminating most bargaining rights. To avoid laying off 5,500 state workers, he has introduced legislation requiring that they contribute 5.8% of their income towards their pensions and 12.6% towards health insurance. Walker also wants to limit the power of public-employee unions to negotiate contracts and work rules. His proposal prevents the unions from seeking “pay increases above those pegged to the Consumer Price Index”, and prevents unions from forcing employees to pay dues
The goal, according to the governor, is to balance the budget while avoiding layoffs. However, organized labor is concerned about a decline in membership which will lead to decreased finances and political influence. Thus they see this as an attempt by Walker to reduce the clout of unionized public employees in Wisconsin.
As states face cutbacks in services, public support for unions is decreasing. The growing view is that generous union wages and benefits are in large part responsible for the financial crises in many states. Faced with a choice of increasing taxes or reduction in workers’ benefits, public sentiment is leaning toward the latter.
These measures will affect the Democratic party which has long counted on organized labor. President Obama is walking a tightrope, faced with the desire to support unions on the one hand, with recognition of the need to cut spending in order to reduce the debt, on the other.
Thousands of public employees have converged on Madison, Wisconsin, in attempts to scuttle Walker’s legislation. Unionized teachers have left schools, forcing school districts to cancel classes, and leaving thousands of students stranded. Democratic State Senators have left Wisconsin to avoid voting on the measure, promising to return only if certain measures are removed. .
Temperate language has become a casualty of this conflict. According to Republican representative Paul Ryan, “It's like Cairo has moved to Madison”. And Paul Krugman of the New York Times says that Governor Walker is trying to make Wisconsin “a third-world-style oligarchy” Gene Gowey of the Teamsters compared the Governor to Adolf Hitler, while State Senator Spencer Coggs accused Walker of creating “legalized slavery.” What happened to the call for greater civility?
One problem faced by many of the protestors is the possibility of disciplinary action for unexcused absences. It is possible that absent employees will have their pay docked. However, if they provide a doctor’s note, the absences could be considered excused and the employees would be paid for protesting.
Last weekend, a group of individuals, wearing white lab coats and claiming to be doctors, were handing out medical excuse notes. According to witnesses, they were giving the notes to people who were feeling sick “due to emotional, mental or financial distress”. There were no medical examinations of the recipients. One doctor pointed out that all those demonstrating “had symptoms, perhaps a migraine, diarrhea, or insomnia”.
The notes specifically state “This is to confirm I have seen and evaluated the above named patient. Please excuse from work/school due to a medical condition. This is followed by the physician’s signature, name, and Wisconsin license number.
Family physician Dr. Lou Sanner of Madison, said he had given out hundreds of notes. He stated that many of the people he spoke with seemed to be suffering from stress. Other physicians have been identified including Drs. Hannah Keevil, and James Shropshire.
Well, so what? Aren’t physicians entitled to all the same rights as other citizens? Doesn’t this include the right to participate in political activity?
Yes, but… There are at least four problems, medical, legal, and moral, raised by the use of these notes.
First, it is fair to ask what message this sends to the students of the protesting teachers about the uses and abuses of excuse notes. If the teachers are role models, what are the students learning about honesty?
Secondly, we have the legal problem of fraud. The workers will use these notes, obtained after a three second evaluation, to justify their absences and receive pay for time away. This is both dishonest and costly to the taxpayers of Wisconsin.
Third, this raises a question of proper medical diagnosis. There is no state or province in which it is considered acceptable medical practice to make a diagnosis without taking a history and examining the patient, As a physician, if I give a doctor’s note to someone without proper medical evaluation, I have committed malpractice and engaged in unethical behavior.
Finally, there is the question of the impact on patients when physicians publically engage in political activity. There are reasons why it is considered unethical for physicians to post political signs, or leave political literature, in their waiting rooms.
Imagine a political or social position on which you feel strongly. And now imagine that you are a patient of a particular doctor, and you see them for a serious illness. How would you react if they were on the “other side”, supporting an issue that you opposed, or endorsing a candidate whose views you find reprehensible? Can you feel that they would still be compassionate toward you?
Patients need to trust their physicians, and believe that their health comes first. Will this information about your doctor impact in any way on your illness? How will it affect your trust in that physician? Will it influence your judgment of that doctor’s intellectual acumen, integrity, or professionalism? Will you continue to respect that person’s medical judgment?
When we go to a lawyer for help with legal problems or to a psychotherapist for help with emotional problems, we do not expect or want the person consulted to step outside the role for which we chose them and suddenly tell us how we should vote. Similarly, when patients go to doctors, they want medical advice, care, and alleviation of suffering. The stimulus that initiates the patient-physician encounter is a health concern, not a desire to become politically embroiled.
When a physician offers a political opinion, whether verbally, by leaving literature in the waiting room, or by helping protestors with fake excuse notes at a partisan political rally, he is blurring the boundaries between his responsibilities as a physician and other unrelated areas. Advocating for a particular position or candidate may suggest to patients that their views are “wrong” and make them feel unwelcome by that doctor. .
It is not unreasonable for patients to wonder whether their physician will feel a special kinship with the patient who shares his political views and act with indifference or distaste toward those who do not. Political opinions are not facts, and they especially are not medical facts. The doctors who are writing fake notes in Madison are blurring the boundaries between what is political and what is medical.
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