Israeli Doctors Seek Law Excusing Them From Writing Sick Notes

If legislation is enacted, workers would be allowed short sick leaves without the need for doctors' notes, though longer leaves would still require a sick note.

A Health Ministry advisory committee intends to recommend limiting family doctors' non-medical workload, like filling out sick notes to enable patients to get paid leave from work.

"Various institutions and organizations require family doctors to certify all kinds of things that have nothing to do with their medical work and have no medical significance," a longtime family doctor said at a National Council for Community Health conference over the weekend. "This turns the doctors into rubber stamps."

Doctor Hadassah Hospital
Olivier Fitoussi

The council, whose family medicine unit is headed by Dr. Amnon Lahad, said it would recommend changing the law to reduce the need for such medical certification.

If such legislation is enacted, employers would have to allow workers to take short sick leaves without a doctor's note, though physicians would still need to document the need for longer absences.

Today patients are required to get a clean bill of health from their doctors before they can sail a passenger ship, run a marathon, and get a job in certain public institutions, including local authorities. Prisoners also require such notes before conjugal visits are approved.

Family physicians are also required, in accordance with the Health Ministry's new procedure for home births, to issue a certificate regarding the physical and mental fitness of any mother planning to give birth at home.

"Instead of turning the family doctors into policemen, we must consider enabling workers to give a statement regarding absence from work from three to seven days, and compensate workers when they retire if they haven't used up their sick leave," a senior council member said. "This is the procedure in many Western countries."

In most West European states and the United States, workers are required to show their employer a doctor's note only if they are away from work for several days, he said.

"A request for a sick note is very subjective," said Shlomo Vinker, chairman of the Israel Association of Family Physicians. "For example, someone who is hoarse or lost his voice can continue working if he works in front of a computer. But in the case of teachers, they need a sick note because they can't function in the classroom. Today doctors are required to act as investigators, but in reality most doctors give the patients what they ask for."

An Israeli study published in October 2010 in "Harefuah," one of the Israeli Medical Association's periodicals, corroborates the family physicians' arguments. The study, based on data from 47 clinics that treat some 60,000 people, finds that the overwhelming majority - 99.2 percent - of the patients who asked for sick notes received them.

Beyond the stated reason for the sick notes, family physicians listed other reasons in about a quarter of the cases, such as the patient's request (81 percent ), psychological problems (2 percent ), relatives' medical problems (2 percent ) and concealing pregnancy from the employer (2 percent ).

Some physicians said at the conference that some patients ask for and receive sick notes due to reported stress at work, resulting from worsened relations with their boss.

"If a patient reports accelerated heartbeats, palpitations and sweating at work and needs a brief rest at home, I'll give him a sick note," said one family doctor. "If he says he has diarrhea, I have to be believe him."

The Clalit health maintenance organization is planning to enable patients to obtain sick notes over the Internet as part of its new online services due to be launched soon.

Read this article in Hebrew.