{"id":38,"date":"2008-11-27T15:07:27","date_gmt":"2008-11-27T14:07:27","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/medical-ethics\/?p=38"},"modified":"2008-11-27T15:07:27","modified_gmt":"2008-11-27T14:07:27","slug":"fit-notes-undecaffeinated-coffee","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/medical-ethics\/2008\/11\/27\/fit-notes-undecaffeinated-coffee\/","title":{"rendered":"Fit notes? Undecaffeinated coffee?"},"content":{"rendered":"

I’m not sure whether it’s an urban legend or actual fact, but\u00a0I once heard a story about someone who was offered coffee on an aeroplane in either decaffeinated or undecaffeinated versions.\u00a0 Oh, how I laughed at the mindless pleonasm.<\/p>\n

I only mention it because I was awoken this morning by the sound of someone talking gibberish on the Today<\/em> programme.\u00a0 (Plus \u00e7a change<\/em>, and all that…)\u00a0 This particular brand of gibberish concerned those who are on long-term sick-leave, and what can be done to get them off it.\u00a0 The proposal was that sicknotes should be replaced by “fit notes” outlining what people can do, rather than outlining what they can’t.\u00a0 And, wouldn’t you know it, the government seems to think that this is a good idea<\/a>.<\/p>\n

It isn’t.\u00a0 It’s undecaffeinated coffee.\u00a0 There’s about a bazillion reasons why: here’s just a few.<\/p>\n

    \n
  1. We can take it as read that most people are capable of most jobs.\u00a0 This is because most jobs have to be filled by someone, and so don’t demand superhuman abilities.\u00a0 So we can assume that, absent evidence to the contrary, people are capable of pretty much every task.\u00a0 And that means that specifying the tasks that a person can<\/em> do will mean writing out an indefinitely long list.\u00a0 Put another way: it’s inability that’s the exception.\u00a0 It’s a much better use of time to concentrate on the comparatively few things that a person can’t do\u00a0– which is why they’ll have sought\u00a0a doctor’s note in the first place – than on those that they can.<\/li>\n
  2. On a similar note, “fit notes” assume incapacity as the default position.\u00a0 Capacity is thereby treated as noteworthy.\u00a0 That seems odd.<\/li>\n
  3. It also ignores the fact that one of the factors in so many people being on the sick is that there’s been a history of shunting people there based on a system that incentivises the removal of people from unemployment benefits.\u00a0 That way, they aren’t “unemployed”, even when they patently are.\u00a0 Ben Goldacre has written on this, and made a very good radio programme about it<\/a>.\u00a0 The point, as far as I could tell, was that there’s an arm of government policy that, like it or not, promotes long-term sick leave as a way to massage the jobless figures.<\/li>\n
  4. It alters the role of the GP from one of certifying that a person has a problem to herding them into work of some sort.\u00a0 I think that GPs probably have better things to do.<\/li>\n
  5. And, anyway – wouldn’t it encourage people to find ways to fiddle the system if their means of honestly establishing that they can’t work were to be – at least in perception – replaced by a means of their having to defend themselves?\u00a0 What about the trust in the doctor-patient relationship?<\/li>\n
  6. Look at it this way: doctors would be implicitly expected to treat patients as workshy skivers, whose abilities are kept hidden so that they can live a life of hand-outs and daytime TV.\u00a0 There’s no assumption of good faith here, and that’s corrosive of humanity as a whole\u00a0– GP or non-GP.<\/li>\n
  7. et cetera.<\/li>\n<\/ol>\n

    Naturally, none of this means that we shouldn’t be trying to get people of incapacity benefits of whatever sort.\u00a0 Of course we should – people are much happier, richer, healthier if they’re in regular work and they usually have a higher income than they would on benefits.\u00a0 As a taxpayer, I’d be happier, richer and healthier if those people were working, too.\u00a0 But, really… this kind of fluffy stuff seems to miss the point by at least th—————————————is much.<\/p>\n

    Or is it me that has missed the point?\u00a0 Regular readers might well think that that’s something I do as a matter of course.\u00a0 *sigh*<\/p>\n","protected":false},"excerpt":{"rendered":"

    I’m not sure whether it’s an urban legend or actual fact, but\u00a0I once heard a story about someone who was offered coffee on an aeroplane in either decaffeinated or undecaffeinated versions.\u00a0 Oh, how I laughed at the mindless pleonasm. I only mention it because I was awoken this morning by the sound of someone talking […]<\/p>\n

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