Sunday, January 27, 2013

Jobs, Doctor's Notes and Modern Reality

I've been sick; real sick.  It started when my wife and I were awoken about 2:30 AM one morning by our 14 year old son who was vomiting.  It is never the morning greeting that starts the day well.  By about 4:00 PM that day, I started my bout.  I had been experiencing a flair up of my diverticulitis a couple days prior and had upped my dosage of fiber.  I believe this may have compounded the impact of this stomach bug as the retching definitely exacerbated the stomach pain of the diverticulitis and I believe the fiber helped to set me up for uncontrollable diarrhea in addition to multiple episodes of vomiting.  I have no doubt that I became severely dehydrated and it was a huge struggle just to make my way from my chair to the bathroom.

Unfortunately, my employer has one of those arcane policies whereby if you are out sick for 3 days, you need to return with a doctor's note.
 This is one of those policies that may have sounded good at one point in time, but I believe has quickly fallen out of touch with modern reality.  If you see a doctor in the course of treatment, that is one thing and perhaps may not pose much of problem.  However, the practicality of running to a doctor for examination for every episode of care is a bit impractical today.  First, in my present example, at my peak, I was in no condition for a transport anywhere.  As I've stated, I could barely walk to the bathroom; a trip to the doctor in such a condition would have been simply too much.  Thereafter, it makes little sense to me to go to a doctor if you are seeing improvement in your condition.  Such behavior only contributes to the spread of communicable diseases; in this situation I would easily put others at risk and considering my compromised health, others may put me at risk.

I will also note, that this "3 day rule" originates from a period about 20 years ago when health care costs were not a big consideration.  Your yearly medical insurance was relatively inexpensive back then and when you did access care in those days, you generally paid only a nominal amount like $5 or $10.  Thus, cost was not, historically, an issue as it was so trivial that it was not worth arguing about.  However, times have changed; plans are no longer as generous and the variety of plans also impacts the cost.  Today, most HMO rates for an office visit involve at least a $20 co-pay and it gets worse for many other plans.  For example, there are High Deductible Health Plans (HDHP).  In this example, the episode of care is in January so unless you've been very unlikely, you will not have paid your high deductible if you have such a plan.  Simply stated, if you have a HDHP, you likely will be left with paying the full bill... a typical office visit for me generally runs at least $120 - $80 for the office visit plus $40 for the lab tests that they will certainly run.  This expense is no longer insignificant.  As I have formerly stated, it is one thing to spend this money in the course of getting necessary care; it is quite another to be forced to absorb these costs merely for the purpose of "getting a doctor's note".

So what does this mean to me?  Well, it means that unless I feel I need treatment, I will raise from the grave like Lazurus on the third day and report to work.  While I have targeted this "3 day rule," in this quip as something in dire need of change, I do want to interject a couple of positives in regards to my employer.  First, my employer has pioneered well into the realm of "telework" (working remotely from home).  Additionally, I will also note that I am fortunate to have decent supervisor who is very good in regards to permitting reasonable ad hoc telework days.  In my situation, I was able to work from home when I reported for work on the 3rd day which worked well to stem the risk of passing the virus and although I definitely was not feeling 100% this option also helped me to be much more productive as I was able to go directly to my work without the additional drain of a commute.

While watching the local news, this recent "super virus" was described and it was expressed how contagious and wide spread this stomach virus had spread in the local community.  I found it interesting that the local health reporter clearly stated you should avoid contact with others for at least 3 days... that guidance would certainly be hard to follow for those under the gun of a 3 day rule.  I am aware that most do not have the option to work from home and thus would be placed in a very difficult dilemma of either going into work when they are not 100% well and exposing colleagues OR the expense of a doctor's visit.  For those out there wearing the union label, feel free to send the URL of this post to your union rep.  This is one policy that needs a second look.

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