to say don't go and get signed off with stress

[writingonthewall]

I see this all the time on MN

OP: there's been a death in the family, I'm doing fine but need time off work to organise the funeral/comfort DH. work will only give me 3 days compassionate leave, after that I have to take holiday or unpaid leave

everyone else: go to your GP and get signed off with stress.

before I get flamed, I am a GP and I fully understand that bereavement hits different people in different ways. I sometimes do sign people off work after a bereavement - if you can't stand up for crying, then you can't work. And whilst there is no hierarchy of grief, as a general rule losing a child is very very traumatic whilst losing a parent is something that you do expect to happen at some point. So no problems with signing certificates for genuine mental health problems post bereavement.

What I do object to is this "get signed off with stress" when you aren't ill.

Do people not realise that, firstly, you are asking the GP to commit fraud. Secondly general practice is buckling. We are under resourced (all practices in one area I know are about to lose 20-25% of their funding) and even if we had the money, there are no GPs to recruit. And it's going to get worse if the new juniors contract doesn't get sorted out.

Every appointment taken up with a medicalisation of normal life, is an appointment that someone who is ill can't have and a potential delay in the diagnosis of someone else's cancer or other serious condition.

so please. see your GP if you are ill - physically or mentally. But think before you do and don't involve us in your battles with your employer and your general normal life events. Being sad after a bereavement is normal. The treatment is to talk about the person you have lost, cry a bit, and take care of yourself. It isn't to rush to the doctor for a medical cure.

In my experience there's the grief where you feel sad and weepy when things remind you of the person/animal you have lost, and the grief where the world has shifted on its axis, nothing will ever be the same again, and you simply cannot believe that this has happened. I don't know how a GP can distinguish in a 10 min appointment.

The problem is that grief is different for everyone. And for all of those people who need the time off to enable them to get back to a point where they can function, there are also those who go to the dr's and get signed off because 'that's what you do'.

I found my DM, dead, on her kitchen floor when I went over to see her one Sunday. She was a fit 67yr old, I was 29 - my sister was 25. Of course you're prepared for your parents to die 'at some point', you're probably not prepared to be confronted by your mum's body when two days previously you'd been talking about her upcoming long distance travel, and not before you get to 30. We had no idea how to manage the arrangements required, the person who would have guided us in something like that was dead, and we were both in complete shock apart from anything else. I took three weeks as I was able to delay the start of a new job. My DSis was put under pressure to go back to work by her employer and three months later walked out and took 6 months off as she hadn't had an opportunity to grieve.

My job is high pressured and involves dealing with angry people - I wouldn't have been in any state to deal with the public in those three weeks and as it was, I still don't remember half the decisions I made or emails I sent in that beginning period after her death. On the flip side, I worked through two miscarriages and only had a few days off for the physical recovery following my third which involved an ERPC; I was sad but able to contain it to crying in the toilets and coming home and going straight to bed. Grief affects everyone differently. I'm not sure the bereaved are the ones to target when we're talking about 'wasting GPs time'.

OP you sound heartless and seem to lack the ability to understand what grief is. yes I know you say you understand but I think there is something missing in you, something that is not connecting with other people. That is worrying for a G.P it must be said.
Glad you are not my G.P

I am expecting a bereavement very very soon. The initial stress surrounding this contributed to an absence from work with severe anxiety before Christmas. I am now back at work but feel as though I am operating in a fog on auto-pilot. Even though I know it is imminent, I have no idea how I will feel/react when the inevitable happens.

I have had one day's compassionate leave (paid) and therefore any further leave I take, other than for the funeral, will be unpaid. I teach, so I can't schedule things via annual leave. It sucks.

Bigbutoons I think op is saying grief is grief and sickness is sickness. They're not interchangeable

I don't think you are unreasonable at all. I think some people have missed some of your message. Grief is an awful thing and if you genuinely cannot cope then yes, see your GP but if it's just to get some extra time to sort things out I don't think it's particularly fair on anyone. If anyone feels they need a few extra days to sort things out you can self certify for 5 days if needs really must and your work aren't open to extra time, but I do find a lot of the time if people sit down and speak to their work in an open and honest manner, a lot of the time they do allow extra time. But it's no reason to clog up GP services for no reason, yes if you genuinely do have stress that is causing great effect to your day to day life and you can't cope but otherwise it's not helping anyone.

No, they're not. But if grief is causing someone to be incapable of functioning on a day-to-day level (I.e managing normal interactions with people, performing a job), then is it any different from any other mental health problem? Because after all, that's the reason that people with mental health problems get signed off work - that they have a problem which is causing them difficulties in functioning.

A really difficult topic but I totally get where the op is coming from but I also agree with the fact that employers do have a responsibility too. Problem being that abscence incurs costs. Within teaching, on current supply rates, covering a teacher can cost £1000 a week (the supply doesn't get all that, it includes agency costs) and even with insurance the cost would still be around £400 a week. Where is the money meant to come from? You can budget for a number of bereavements per year and, obviously, grief affects people in different ways. We do let staff have three weeks, paid leave, not necessarily all at one go, that's up to them, but it costs. However compassionate you want to be, as an employer, in the public or private sector, you have to balance the books, regardless of sick notes.

Mrsdv I completely agree. It's up to the workplaces, not their gps.

In this country, death, grief and the process of arranging funerals are all things we'd rather not talk about. People do need time to arrange these things and quite frankly, I would get signed off until more sympathetic employment laws recognise this.

YABU.

I should clarify and should have said. I get at least one or two people a year wanting to be signed off from work for sigicifant period of time because a pet has died. That bit of my OP somehow got lost and I agree my example didn't make much sense without it

That's possibly the drip feed of the century!

And what if your annual leave is already allocated/you don't have any left? You just take unpaid leave and lose money? Hardly fair.

It's not really about fair, but rather who bears the cost. Sometimes you'll need to take time off work, and if you don't have any annual leave left you'll have to take a pay cut. Ultimately, this is one's own responsibility.

What percentage of your patients would you say were asking for sick notes when they don't need them? Is it a big problem? Or something that winds you up because it's frustrating when you're overloaded?

Yes sorry uptheroad I thought I'd put that in my OP but all the comments made me go back and check and I realised I hadn't. Hence the

And for at least the third time I am not talking about those with depression or disabling grief

I think it is very difficult, as a physician, to be in the normal physician role of patient advocate, but to also be expected to ferret out fraud in the case of people asking for unwarranted time off, whatever that may mean.

The main GP professional body could help by setting (generous) standard allowances, which individual GPs could follow. That would take the heat off of GPs somewhat.

P.S. I am a physician, but in the US, and I have sympathy for the ethical conflict that must be inherent in being asked for sick notes in the UK where they are more liberally requested than in the US (not necessarily a bad thing, mind you.) Here I generally find myself only asked for sick notes for discrete, easily definable periods of illness. But this may be because employers here can be very stingy with sick leave.

It's pretty obnoxious to say that the OP doesn't understand grief: that's really not what she is communicating here.

I hardly ever go to my G.P.

Last time was nearly four years ago.

I'm quite shocked that of all the things the OP could have honed in on to criticise, bereavement is the one.

As a fellow GP, I completely understand what OP was trying to say.

We get asked for a lot of sick notes and it does take up lots of appointments unnecessarily. Most people don't realise that you are not entitled to a sick note until you have been off ill for 7 days, and I have a lot of wasted appointments where the patient goes away empty handed for this simple reason.

A lot of employers don't understand this either and send employees in to get sick notes on day 1 of their absence which is hugely wasteful of everyone's time.

I think the general public don't have any idea of the crisis that most GP practices are facing. I suspect this it the reason for OP's post. I'm not even sure general practice will exist in 15 years time. The long hours (at least half of which is doing paperwork - sigh) and increasing demands are putting junior doctors off going into general practice and Gp's are retiring at 55 as they are burnt out.

I'm not moaning about this, but it is the reality.

My dad suddenly of suddenly in August even though he had a long standing medical condition. It was also the first day of our new school term. My GP signed me off without question for a fortnight stating "bereavement". He didn't even need to see me, he is our family GP and had visited my mum and I the day it happened. He then signed another line for a week as we hadn't had the funeral by the end of the first fortnight. I can see both sides here, the OP's as a GP and many of the PP's points of view too.

Very surprised at all of the posters who are selectively quoting the OP about her dog, whilst busily ignoring the part about the death of her Father. I can only assume they can't read properly.

I agree with you OP. It's a pity that the point you are trying to make - about unnecessary use of scarce resources - is being lost in a sea of posters who are too busy bashing you to actually think about what is being said. Accusing someone of having something 'missing' in them or that they are 'vile' because you disagree with their view - oh the irony!

There are always going to be circumstances where someone needs additional time off. There are going to be times where perhaps a GP needs to ask some additional questions to make sure that someone is not soldiering on when in fact they should have some leave, to avoid problems further down the line. Mrs DV's situation is heartbreaking and a very good example of that. It's inevitable that some GPs won't ask the right questions, or will refuse to sign people off when they actually should do - nobody gets it right all the time and not everyone is doing the job they should be! However I do think it's right to ask questions - gently and sensitively - about the circumstances surrounding the bereavement, so that the GP can assess whether they think it's appropriate to issue a sick note. After all they are being asked to state, that in their medical opinion the person is unfit for work. To issue a note when they are not convinced this is the case, is dishonest.

I have lost friends and relatives. I have had 'expected' bereavements (elderly grandparents who had been poorly for some time), and I have had very sudden bereavement in distressing circumstances (a teenaged sibling), so when I am talking about my views on this it's not from a position of academic rather than actual experience.

I understand that Octo, I really do. What I don't understand is, why bereavement?

Don't you come across a lot of not really stressed, not really depressed, not really anxious people?

Don't you come across plenty of people adamant they have flu when it's a cold?

All I know is I had a very sudden and unexpected bereavement nearly two years ago and it knocked me for six. I won't pretend to know what MrsDeVere went through, but it's fair to say it took me twelve months to feel like myself again.

I do think there's a bit of a hierarchy of grief, but I also think circumstances have to be taken into account. I was in my early 30s when my dad died suddenly - maybe if I'd been 50 and Dad 85 I'd have been more inclined to think it was the natural order of life: as it was it didn't feel very natural.

I sympathise with G.P.s, but I don't accept grieving individuals are solely responsible for the stress they are under or the beaucracy. I think chancers trying to get sick notes absolutely need dealing with but I just don't understand why those grieving have been singled out here.

I think being signed off work for the death of a pet can actually be about more than the cat/dog itself.

I was off work for 3 months after our cat died. Even I thought it was ridiculous I was in such a state over a cat. Thankfully the GP realised that the cat was my last physical link to my grandparents and I was actually grieving them and the fact that I had no parents to help me through losing my grandparents or the rest of my life.

Grief is like many things in life - it's not black and white.