Last night I attended a meeting between our hospital administration, our local department of Social Services and several of the doctors like myself who serve the poor in our community. The topic was medical exemption from work for people who appear to be able, perhaps, to, well, actually work.
It's a difficult topic. We want people to work. ALL of us want everybody who is capable of working to pull their own weight and get a job - not one sensible soul will argue with this. So Social Services gave us a general outline of how many people fall into the "We think they could work but they aren't" category.
It was a surprisingly small number.
Social Services in this county has 900 people in and out of their doors DAILY. The majority are pick up/drop off of papers and cards. Up to four a day are homeless and seeking assistance. The largest percentage of assistance is medical insurance, Medicaid, and SNAP (food stamps). They assist in tapping into relief for heating bills (HEAP). They help a small minority of mothers and children with cash assistance ('welfare'). They help newly disabled people until they can get hooked up to Social Security Disability. And the smallest number are single adults who are out of work for whatever reason. They require that these folks actually work in programs that serve the community and/or train them for work - unless a doctor says they can't.
Patients bring me papers all the time asking for work restrictions for Social Services.
So here's the thing: How often do we, as doctors, simply give up/give in and just sign the paper to get the damned thing off the desk? And some of the discussion last night centered around how qualified we are to determine, really, whether or not some can or cannot work, especially when their limitations fall outside of our 'scope of practice'? Family practitioners are not psychiatrists, after all.
It was certainly food for thought.
I admit that I am less mindful than I should be about these forms, and I will be more vigilant, especially with people I don't know well or have some mental reservations about. But...after nearly twenty-six years in this neighborhood if I can't spot someone who cannot work due to mental illness (the most recent one I signed off had been hospitalized with active suicide attempts three times in the past six months, typical of her last 5 years of life), then I need to retire. Having an independent medical examiner tell me my patient needs counseling is a no-brainer. Finding a place for a poor person to get that counseling is a bigger challenge. Getting a truly mentally ill patient to manage to keep those appointments - wow.
Some of what I learned was good information, though. If I suspect mild mental retardation, Social Services can have a patient tested for me if I request it, and although they can't arrange mental health services they can arrange comprehensive mental health evaluations, acquiring useful information for us to help us make better choices for the people and the communities we serve.