A few weeks ago I received a phone call at work from Centrelink, our blessed government welfare agency. Usually when they call doctors it’s to verify that their clients haven’t been falsifying medical certificates to exempt them from job-seeking activities or to ask further details about a patient’s medical condition on one of their thousand forms (which they so commonly misplace). This time when they called me, it was to ask another request of me: to diagnose a medical condition that would label my patient as permanently disabled. Wait, what?! To make my patient sick? To label my patient as sick? But, more intriguingly, why? And here was the Centrelink officer’s reason: because it was getting to be too much hard work to try to find this patient work!
I get it; sometimes the patients want us to give them a medical certificate to excuse them from work for a few days, almost always for very legitimate reasons. Then those who would cheat the system regardless of whatever system was in place want us also at times to write similar certificates to secure government disability pensions, have their airfares or gym memberships refunded, to postpone academic assessments, to get those much-coveted disabled parking permits, etc. etc. But this “please diagnose disability” did not seem to me as a simple request (even though you could very rightly refer to it as a request to be a co-participant in federal fraud); it was at least to me about something much more than about money. It also was not something the patient himself has asked of me.
I’ve previously discussed about the dangers of labels. And surely also some labels have their advantages, for example, in forming self-identity and bringing likeminded people together. However, my concern at this particular request was (aside from the fact it is at least unethical if not illegal to lie about a patient’s medical condition) about the effect labelling my patient as disabled, as ‘writing him off’, would have on him. The patient had seen me previously and not asked that I fill out any Centrelink form and surely did not mention about considering himself unfit for work due to physical and/or mental limitation. As almost every other patient that walks into a consulting room, their focus was on getting better and that was what we discussed – and one reason he wanted to get better was that he was keen to re-enter the workforce and get on with other socially-enriching activities of life! This reason especially is why the Centrelink officer’s request so surprised me. Of course I asked her to not just send me forms but rather to send me the patient back because I wanted to ensure we were all on the same page.
In short, the Centrelink officer’s agenda was an act of desperation because she was struggling with her own job: helping my patient find paid employment. It is very much easier in this, as in many other “people jobs”, to just give people what they want despite the company policy or government rules or laws or our own position on a matter. It’s the easy way, right. But the easy way is so rarely the right way. What I’m trying to say is I don’t blame this poor public servant for wanting to make perhaps two people’s lives easier. What I do, however, have a problem with is to allow this person (the patient) to opt out of life.
I say opt out of life rather than opt out of the workforce or even opt out of ‘effort’ not to be dramatic, but because a simple fact of human life is that in the majority of situations we define ourselves by our work. Think for example how when you first meet a person one of the first few questions you ask them is what they do ‘for a living’. Knowing this tells us a lot about a person, yes based on stereotypes, but in education stereotypes are one of these essential things for learning. Knowing what a person does for work tells us about their education, their finances, their likely social circles, etc. But, of course, none of these things are of primary importance and the stereotypes fade once you get to know the individual. Have you ever been unemployed or met someone who is unemployed and they referred to what they previously did for a job or what they’re looking into getting? It’s a bit of a matter of healthy pride, to let you know that they are still a part of human society.
I have previously touched on the concept of maintaining societal involvement in order to preserve our mental health. The DSM defines mental illness by a variety of particular symptoms, and furthermore that they cause significant “distress or impairment in social, occupational, or other important areas of functioning”. For example, we all have felt sad but not as many of us have been so sad that it interfered with our ability to shower or eat, etc. for weeks or months and so being able to be rightly diagnosed with depression. OK, but here I am discussing not mental illness but rather societal involvement. Mental illness leads to decreased involvement, but it also worthwhile to consider that the decreased involvement can also exacerbate negative mental states. As I have mentioned in a previous post, one of the methods used as punishment in our society is imprisonment. The punishment isn’t just about keeping you separate from your family, friends, and other people, but also of depriving you of all other types of social environments such as work.
So, let me summarise why this whole incident caused me such a dilemma 1) it was not a request by my patient but a third party, and 2) I didn’t feel right about labelling my patient as disabled, and 3) I didn’t want my patient to be excluded from societal involvement and be exposed to the negative effects that come with it.
No comments:
Post a Comment