Stephen M. Perle, DC, MS
Politics often makes great theater. A good example of that is the situation in Wisconsin, where the governor recently signed legislation limiting state workers' rights to collectively bargain. My intent here is not to enter into this political debate, but to note that thousands of state workers have descended upon the capitol in Madison over the past several months to protest the governor's action. Why weren't they working? From some news reports, it appears that many had a doctor's excuse from work. They were "out on disability."
I am sure that this kind of situation has confronted all of us at some time in our professional lives. A patient might ask for a "doctor's note" to get out of jury duty or to avoid paying a fee for changing an airline reservation. Then, of course, there is the excuse from work for a patient who really isn't hurt that bad or, as in the case in Wisconsin, isn't hurt at all, but just wanted to get paid for a day off or not be disciplined for missing work. Providing a doctor's note for any of these may seem like no big deal for the doctor. You are helping out the patient, aren't you?
As with many things like this, it seems to the doctor that no one is harmed by a "little white lie." It may appear that no one is harmed because those who are hurt are the "big bad" government, airlines, judicial system or business that is not sitting right in front of us as the patient is. This situation is analogous to Stanley Milgram's classic shock experiment from the 1960s: The farther the distance between us and those we harm, the easier it is to cause harm. This may also be the reason doctors can appear to have a clear conscience while committing insurance fraud – the insurance company is not sitting right in front of the wrongdoer. Somehow, that seems to make it easier. And again, it's just a "little white lie," writing a doctor's excuse from work, right?
But in Wisconsin, there has been a call to have the regulatory agencies investigate the doctors who have provided the medical excuse from work for the protestors. Some might think this is an impossible quest, but not really. Think about it – the schools and other government agencies know the names of the employees who submitted doctor's notes. There's been enough media coverage that an administrator could watch the footage and see their "sick" employee. You can connect the rest of the dots. It would be very easy for an investigator to go to a doctor they suspect of giving out excuses from work and pose as a patient seeking a similar excuse.
What does this mean to the doctor? Well, these doctor's notes are given to state agencies. Providing false reports to state agencies is probably a crime in most states. All of a sudden this "little white lie" could become a cause of action that could result in disciplinary action against the doctor's license.
The interesting part of this violation of one's veracity duty is that unlike insurance fraud, the doctor's notes most probably did not enrich any doctor one red cent. Most of the patients just called and asked for a note without an office visit. They basically called the office and said, "Can you help me out.?" In fact, one could argue that this is done in fulfillment of one's fidelity duty to the patient and it is the patient only who benefits from the lie.
Nevertheless, if the state decided to pursue the doctors, this lie could cost thousands defending oneself before regulators. For while we have ethical duties to patients the social contract says that professions exercise their autonomy granted by society for the betterment of society. Normally, the needs of one's patient supersede the needs of society, yet licensing – the way society keeps a watch on our behavior – anticipates we will discharge our duty honestly.
The line in mob movies and TV shows is ,"Don't do the crime if you can't do the time." One must be careful because sometimes, the crime is just a "little" deviation from the truth, but for which there still may be consequences.
