Right-wing groups witness doctors giving sick notes to protesting teachers in Wisconsin

Incidents underscore the need for physicians to separate personal beliefs from professional duties

 
The standoff between Republican and Democratic lawmakers in Wisconsin over Gov. Scott Walker’s bill to limit collective bargaining rights for unions has entered its third week, and the around-the-clock footage of outraged protesters has ended.

 

But what remains, if you search hard enough online, are several video clips of doctors standing among demonstrators with stacks of form sick notes, signing and handing them out freely to protesting teachers—official documentation that would excuse them from work.

 
Citizen journalists for a few right-wing groups pretended to be protesters themselves and, while secretly filming, asked the sympathetic physicians for a sick note.

 

As a red herring, the stunts caused a relatively light ripple in the media. But the videos clearly caught the physicians red-handed. “A doctor’s note is a serious document,” Ford Vox, a brain injury physician, stated in a Feb. 21 article that he wrote for the Atlantic. “It represents an employer’s desire to verify through a respected, independent, medically qualified third party the fact of an illness and the true need for convalescence.”

 

Peter Terry, M.D., a core faculty member of the Johns Hopkins Berman Institute of Bioethics, agrees. After briefly viewing the videos for himself, Terry said that the doctors clearly handed out their notes without a proper medical evaluation.

 

“A doctor writes a sick note only after thoroughly taking a history, and physically examining a patient,” said Terry, a professor at the Johns Hopkins University School of Medicine. “Furthermore, a physician caring for a patient is obligated to keep medical records of the encounter with the patient. There were no such records that I could see.”

 

Although ethical violations of trust and truth-telling were evident in the videos, Terry said he wasn’t overly concerned, either. “These events likely represent the actions of a few well meaning, but ethically confused physicians, and society will view them that way,” Terry said. “Were these sorts of acts to become commonplace, then the cumulative effect on society might be to view physicians as being unable to separate their personal feeling from their professional obligations.”

 

Vox identified the physicians in the videos as faculty from the Department of Family Medicine, at the University of Wisconsin-Madison. As public educators themselves, the doctors were likely eager support the protesting teachers in any way possible.

 

For its part, the Wisconsin Medical Society provided the physician-journalist with a cautious response, and has since posted a statement on its website by Timothy Bartholow, M.D., senior vice president of member services, policy planning and physician development.

 

“The Wisconsin Medical Society was notified during the weekend that physicians may have been writing work excuses for people attending rallies at the state Capitol in a manner that is not consistent with acceptable medical practice,” the statement begins. “If these reports are accurate, the Society does not condone these actions under any circumstances.”

 

Not exactly a roaring condemnation. Nonetheless, the awkward position that the organization feels it has been placed in by this apparent transgression comes through loud and clear.

 

Moreover, the incident raises a crucial question of what education or guidance physicians do receive on how to keep personal beliefs and professional obligations separate—and how they should behave in situations that touch on both.

 
Professional societies such as Wisconsin’s probably cannot, nor should they, say much about the politics of their members, says Margaret Moon, M.D., a core member of the Berman Institute’s Program on Ethics in Clinical Practice. But such groups do have good reason to comment when physicians bring medical practice into a public arena.

 

Moon focuses on ethics education in the clinical and pre-clinical setting, and on ethics and professionalism in outpatient care. She said physicians being asked to lie for the benefit of a patient is one of the specific problems she has observed in the pediatric outpatient setting.

 

For instance, Moon said she has seen doctors in training being asked to send letters to the housing authorities or to the gas company that imply—or even overstate—medical needs to help patients get better housing or avoid having their utilities shut off.

 

Moon said the sick notes handed out to the protesting teachers fits into that category, although loosely. She also agrees with Terry that the integrity of those notes was weakened by the fact that the doctor-patient relationship seemed non-existent.

 

“Our general teaching is that lying is not really part of the doctor-patient relationship,” Moon said. “Trustworthiness is an important part of that relationship, and lying, even in the patient’s interest, is likely to damage trust in the long run.”

 

Terry also wondered about one other minor issue: Did any of the doctors in the video cancel appointments to attend the protest?  “If so,” Terry said, “they were depriving legitimate patients of care.”

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