A lot of times, social media can be a dumpster fire. But sometimes, there are people on social media who make interesting points, and such was the case with one quote I came across:
“Requiring doctor’s notes to excuse absences due to illness is inherently classist in a country w/o universal healthcare and I really wish we talked about it more.”[1]
Upon thinking about this tweet, the person who tweeted it was right: requiring a doctor’s note to excuse absences due to illness is classist in the United States, a country that unfortunately lacks universal healthcare. So, let’s talk about it more.
Many schools and workplaces require someone who’s been out sick, and particularly someone who has been out sick for more than a certain period of time, to give a doctor’s note explaining the person’s absence upon their return to school or work. For many of us, in the cases of a multitude of illnesses (though not all illnesses), it’s simple enough: you go to a doctor, you get something checked out, you find that you are ill with something that keeps you out of school or work for several days or a couple of weeks (like strep throat, an ear infection, etc.), the doctor gives you a note to present to a teacher or employer showing that you were indeed sick with something, you give the note to your teacher or employer, and then you move on.[2]
In the United States, where there is not universal healthcare, not everyone has health insurance because not everyone has a job with insurance or afford to buy insurance if they lack it through their job. Due to how a lack of health insurance can make it prohibitively expensive to visit a doctor (which seems to cost in the $300-$600 range for those who don’t have insurance to cover the visit, per what I looked up online) or even an urgent care clinic (which is less expensive than seeing a doctor without insurance, but still can be in the $100-$200 range apparently), some Americans have a difficult time affording the requisite visit to get that doctor’s note upon their return to work or their kid’s return to school. What are those people to do?
This problem should be especially noteworthy for employers that do all they can in order to avoid paying for health insurance for employees, or employers (oftentimes small businesses) who struggle to afford to pay for adequate health insurance for their employees. As a result, some employees are unable to afford doctor’s visits in general—an injustice in and of itself that prevents people from getting requisite doctor’s notes and has personal and public health ramifications that go well beyond doctor’s notes.
So what is the solution to this doctor’s note classism in the United States?
The long-term solution is universal, affordable health care of some sort so that every single American can be able to go to the doctor when they are unwell. This addresses the issue of being unable to afford a doctor’s visit—which enables someone to get a doctor’s note when they need it. But it has personal and public health benefits that go well beyond the ability to get a doctor’s note. However, to be completely realistic, Congress barely got Obamacare passed and signed into law in the United States (inadequate as it may be in terms of providing truly universal care), and the political situation in the United States is somehow even more toxic now than it was then. In other words, my pessimistic realism is telling me that it may be some time before we get truly universal healthcare. I hope I am wrong.
In the interim, I think that many bosses with uninsured or underinsured employees need to be sensitive to the fact that for some employees, all they can do to get better is to simply rest. As such, sick leave policies should reflect that fact. Admittedly, such an approach requires a certain level of trust in employees that some employers lack (and there are unfortunately some people in this world who give reason for having low trust in employees, but there are also many deserving of that trust). However, the alternative is worse: forcing a poor, uninsured person to come into work sick because they cannot afford to get the doctor’s note necessary to show that they are sick.
[1] https://twitter.com/fortunafiasco/status/1048369825045573633
[2] However, it is worth noting that there are some illnesses where things like rest and fluids are needed far more than a visit to the doctor. Asking for a doctor’s note is problematic in those sorts of situations as well, albeit such situations are not the focus of my post here.
Blind Injustice 
In my province, doctors don’t get paid by the public health care system for sick notes, so patients typically get charged for them. The provincial medical association has been advocating for employers to stop requiring sick notes for short absences, as it’s a waste of limited primary care resources.
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That actually makes sense from a policy standpoint, to stop the requiring of sick notes for short absences. Besides, if the absence is short, then extensive intervention from a doctor is not needed in many cases.
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In the UK you can self certify for 7 days, and then need a doctors note for anything longer, but when it comes to long term physical or mental injuries and illness repeatedly having to ask for notes just becomes an embarrassing box ticking exercise. Free healthcare should be a basic human right, like access to water.
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So do you all have to do that box ticking exercise in the UK or not? In know that in many cases with many things, there is some box ticking you have to do in terms of getting a doctor’s note.
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Thank you so much for this important post. As a clergyperson I see so very many situations like this. Curiously, when I saw the heading to the post I thought that it meant that the way doctors write up and speak out situations is classist — phrased in inaccessible language, not suggesting to people the possibility of various treatments, and not allowing time for questions or exuding an attitude that “of course” the patient would not understand.
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Sadly there are too many situations like what I outlined.
And interesting–that’s something I haven’t thought of before–that the way doctors write up and speak out situations can sometimes have its own classism.
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You’re missing an important factor: the ACA.
I am a contract worker and don’t pull a lot of income. I get fantastic healthcare through the ACA. Medicaid is also a thing. These are social programs we all pay for to prevent the very issue you’re describing. It’s not “classist” to expect students and employees to be responsible enough to get themselves healthcare coverage and provide documentation for not fulfilling their end of a contract (which is what they do when they come in). I’m a teacher and I require doctor’s notes from my students if they want an excused absence because otherwise all they have to do to get out of class is lie about being sick. And they do this. A lot. And it slows the whole class down when I have to spend every day catching them up.
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It sounds like you need to revise your teaching method. We are in the 21st century. I assume you are a college teacher, so if your classes are in-person, consider changing to hybrid so that there is only one class meeting per week for instruction, and then the rest is online. Alternatively, if you teach anywhere between grade school and high school, my suggestion to you is to lighten the homework load and instead create lectures on how best to study from a textbook. It truly is a skill that not every kid or student knows how to do to get the best result.
Furthermore, it is classist if you think that all students do is lie to get out of class. It is also ableist, because students could be battling disability and/or mental illness, but because they don’t have health insurance and may struggle with finishing the application, they absolutely don’t feel comfortable with explaining these issues to you because you don’t care enough to find out. You don’t trust them, so they don’t trust you in return.
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