On school requests for doctor’s notes

This is all true, but I also have to think that part of why so many schools ask for doctors’ notes is because their funding is dependent on having kids actually attending. So yes, this is classist and racist, but the problem starts further back, with the public school funding system also being classist and racist.

Rachael Rapacz
February 4 at 9:26 AM
Dear School Administration,

I would like you to know, from a physician’s perspective, what your request for a “doctor’s note from a doctor’s visit” sounds like. It probably sounds reasonable and simple to you. It does not sound that way to me, a parent of three kids and a physician at an urban clinic. This is not the first time I have written a letter like this for an individual patient, but it is the first time I am writing a letter to schools in general on behalf of multiple students.

Many of my patients lack insurance, so a visit to a doctor is terribly expensive. It can be the choice between a meal, or paying rent that month, versus coming to an unnecessary doctor visit. When a visit is for something like a fracture, a laceration, a heart attack, or a serious infection in their child that scares them, people are willing to go in and even go deep into debt at times to see a doctor. However, being told that the sort of illness that means going to school is a really bad idea (fever, GI disturbances, flu) but does not require a visit to the doctor, now requires a doctor’s note is a horrible idea.

They do not need to see me most of the time. Their parent, and most likely the student themselves, knows they have the flu, or viral gastroenteritis, and that they need rest, fluids, and time to get well. Most of the time I would not prescribe them anything beyond over the counter remedies, which they can get at any pharmacy or corner store. It won’t be life threatening for them. However, when your requirements send them into my clinic, they are exposing a whole waiting room and my whole staff to viral gastroenteritis, or the flu, and that includes tiny babies, older adults with immune compromise due to cancer treatments, and pregnant adults, all of whom are at higher risk of dying from those illnesses. Flu is extremely unlikely to even necessitate a clinic visit for a 15 year old. It can warrant hospitalization or even in some cases be fatal to a baby or someone with immune compromise.

That also assumes there is room in my schedule, room that someone else that actually needs a clinic visit could not use better. There isn’t. My schedule is full at least two weeks out most of the time, so when I am trying to work in additional patients my sicker patients get even shorter visits than the back to back visits our broken medical system has decided are standard. That assumes their parent has the sort of job that allows for time to call during business hours and wait through a phone tree (another broken element of our medical system) to get worked in to an appointment. It assumes they can take personal calls at work and that they can wait for a confirmatory call back from the staff after talking to the doc about the work in visit. That assumes that they have a job that allows for time off, and that taking that time off to bring a kid into an unnecessary clinic visit is the best use of the few vacation days that parent was given, or that they can afford to take unpaid time away. That assumes that the parent has easy access to a vehicle to get to whatever clinic they are able to work them into that day. That is a lot of assumptions, and most of them are not true for my patients.

So, there are barriers to them getting in to clinic for this “required note” and you have put threats in place if they do not obtain such a note. (These threats cut even deeper if my patients or their parents are undocumented, by the way. When you flee your home because it is more dangerous to stay there than make the trek through life-threatening obstacles to come live someplace entirely different and not completely welcoming, you do your best to avoid making waves. You make sure to replace your car lights when they go out. You don’t speed or jaywalk. You don’t complain about unfair business practices that don’t allow you to bring your kid to clinic. You don’t attract attention. You definitely don’t risk the truant officer. ) Now you have a situation where a kid, who should not be spreading their viral gastroenteritis or influenza, has to go into school sick. The problem of one sick kid is compounded. More kids get sick. More families make these difficult choices.

Please stop. It’s not serving anyone. It’s harming the kid by dragging them out of bed to a clinic. It’s harming the clinic patients and staff and docs. It’s harming the parents and the families. It’s harming the other students and staff at your school. It’s a policy that comes from a place of privilege and that disproportionately harms the marginalized, the poor, those with less education. As a physician I would always ask you to not choose a treatment that does more harm than good, and this is one of those times.

Sincerely,
Your friendly neighborhood family medicine physician, Dr Rapacz

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