Day it turned nasty when I refused to sign a healthy man off sick

Aconfession: i gave a little cheer last week when Rishi sunak announced that he planned to take away the responsibility for signing fitness for Work certificates (or sick notes, as they are known) from doctors. it’s part of a larger drive to tackle the ‘sick note culture’ and spiralling cost of long-term benefits.

of course, there were the inevitable accusations that he was being callous and ‘blaming people for being ill’. But i agree with him — there is nothing kind or compassionate in allowing people to loll around at home, day in and day out, doing nothing with their lives except watch TV and scroll through social media.

Particularly where mental health is concerned, the research shows that the stability, structure and routine that people get from work is a medicine in itself.

some of those on sick notes, and a lot of those on sickness benefits, don’t want to hear that, of course. But for those of us on the front line, the sick note culture is a daily battle.

it is not only GPs who are asked to produce them — over the course of my career in mental health, i have signed many sick notes, sometimes begrudgingly.

often, in fact, i’ve been presented with a real dilemma. i have some patients who i really think shouldn’t work because they are so unwell, yet when i suggest i sign them off, they refuse, saying they take pride in their work.

on the other hand, i see people who seem to think feeling a bit down, or not enjoying their jobs, means they are entitled to sit at home on full pay or have access to benefits.

i think it is just and noble for a country to support its weakest members. i want pensions and welfare payments to increase — at the moment, they barely lift people above the poverty line. But if we are going to do this, we have to acknowledge that a proportion of people on sick pay, or claiming sickness benefits, don’t deserve it.

How have we got to the point where the welfare state is no longer just a safety net, there to catch you when you are down on your luck or laid low by illness, but instead a feather- filled mattress on which to recline while playing your Xbox? i take the signing of sick notes very seriously, as i’m aware that they are open to abuse. But over the years, i’ve realised how hard it is to challenge patients over them. it has the potential to completely ruin the doctor-patient relationship and, worse, there’s a risk of aggression or even threats and violence.

While i think it is my duty to protect the public purse and accurately assess whether, in my opinion, patients are able to work, i also quite like my face the way it is, thank you very much.

i remember seeing a patient when i first started work in outpatients who had come in for a sick note. He was in his 40s and had been a postman but, for the past four years, had been signed off sick on-and-off due to depression, stress and a bad back. He was very pleasant and polite at first and told me about the twoweek foreign holiday he had just enjoyed. indeed, life was going well, he told me. But he suddenly became prickly and irritable when i started asking him exactly why he wasn’t in work.

‘ What business is that of yours?’ he asked, before i pointed out that as his new outpatient doctor, the person required to sign the sick certificate, it was very much my business.

Since his depression and stress were improving, i said, perhaps the best thing for him now would be a return to work — all the research showed how good that would be for him, after all.

i offered to write to his employers asking that they change his duties to avoid any heavy lifting. i suspected the various beach activities he’d talked about meant his back was on the mend, but i didn’t mention that.

His response was to kick the chair he was sitting on across the room, swear at me and storm out. And who can blame him? Who would want to return to work when you can live for free?

i later learned he’d visited another doctor after seeing me and she had signed him off sick. contrast this with another patient i saw in outpatients recently. she had a serious, degenerative and life-limiting neurological condition, which meant she was unable to walk or stand. she was on a cocktail of medication and, to top it all off, had bipolar disorder and epilepsy. Her medications made her incredibly tired. she was incontinent and had a catheter.

now, this is someone i think it’s fair to say you’d forgive for not working. Yet i was astonished when she told me she was still working full-time in a supermarket. in fact, she insisted on an early morning appointment with me so she could still make it to work on time that day.

The company had made adjustments for her so that as her condition deteriorated, she no longer stacked shelves and instead worked on the checkout on a specially adapted chair and had frequent breaks.

The work wasn’t glamourous but it was important to her — and when i suggested signing her off, she was affronted.

‘i don’t want money unless i’ve earned it,’ she told me.

Are people really saying that everyone with a sick note or sickness benefits is more impaired than this brave woman? i seriously doubt it. if she can get up and go into work, and take pride in the fact she’s supporting herself, why can’t so many others?

THE decline in public toilets really worries me. It can seriously limit lives, especially among the elderly. Many do not stray far from home or confess to not drinking enough. Proper hydration is very important.