Author Archives: Dr. Sicknote

Back in the 1800s the French called it “malingering”. These days Aussies refer to it as “chucking a sickie”. (In the UK, interestingly, you “pull a sickie”, rather than “chuck” it!) In any case, whether you lived in France in the 1800s or in modern day Australia, the meaning is much the same- it’s taking time off work when you’re only a little bit sick, or actually not sick at all.

The fact the French had a word for it for 200 years ago tells us it’s nothing new. It’s human nature to need a quick break from life now and then. But of course, there are those who make too regular a habit of it.

When Dr Sicknote first started out, there was a lot of heated debate- here was a service providing online medical certificates! Wouldn’t it be abused by malingerers? Wouldn’t it give the sickie-chuckers a helping hand? Well, the honest answer to this question is, yes, to a point it might. Because it’s a fact of life- there will always be a small minority of people waiting to abuse any system that is based on trust. As a GP, I see dozens of patients, in person, in my surgery every day. Do they tell me the truth 100% of the time? Of course they don’t! But the vast majority of people are honest. It’s hard to be a good doctor if you start out from a position of mistrust. In fact, I’d argue it’s impossible. And for that reason I refuse to allow my trust in patients be undermined by the tall tales of a few. I therefore choose to welcome every patient I see, in good faith- and with this approach I must accept that sometimes, inevitably, I will end up signing medical certificates for made-up ailments. The bottom line is that the majority of patients benefit from seeing a doctor who trusts them- and this has to be my aim- to serve the honest majority.

And so, on a larger scale, do we deny this honest majority access to helpful online medical services simply because a handful of people will abuse the system? That would clearly make no sense! Especially since such services can reduce Medicare spending and thus the cost to other taxpayers. At present, if a patient chooses to use an online service, they pay a private fee, and are not being bulk-billed or receiving a Medicare rebate. Also, every time a person goes online for a medical certificate or for a minor ailment, they automatically free up a consultation in a GP surgery that can be used for a more unwell person.

Malingerers, sickie-chuckers and sickie-pullers- they’ve always been with us, and they always will be.

But we must not let this prevent us innovating for the greater good!

Melbourne does autumn so well- the trees turn every shade of red gold and orange, and fall wonderfully dry and kickable onto the city streets. The morning sun glares in the window with a low wintry brilliance that tells you you’ll need to wear your coat. The coffee drinkers no longer sip their morning beverages under parasols on the street, but gravitate indoors with their Herald Sun and Age newspapers and laptops. It’s all rather lovely.

But one of the less lovely aspects of this time of year, is the emergence of all manner of viral illnesses, the “common cold”, influenza and viral gastroenteritis to name but a few. GP surgeries heave with runny noses, rumbling tummies, and people queuing for flu vaccines.

So, why does the common cold plague us in winter.? Can being cold give you a cold? We hear mothers calling children indoors on chilly days to put on a hat and coat to prevent them from “catching a cold”. Some recent research suggests there may be at least a grain of truth in this advice- it showed that cold nasal cells mounted a weaker immune response when confronted with a cold virus as compared to warmer cells. But there are probably other more important factors: in cooler weather people tend to gather indoors in smaller spaces, and viruses can be shared very quickly through contact, sneezes and coughs.

There are 99 recognised strains of the common cold virus or Rhinovirus, to use its proper name. There are also numerous viruses that cause viral gastroenteritis. Influenza can manifest in a variety of strains in any given year.

So what can we do to protect ourselves against these numerous and invisible pests? Well, we can vaccinate against some of the, such as rotavirus, which causes a nasty form of viral gastroenteritis- children are immunized at the age of 2,4 and 6 months. The influenza (flu) vaccine must be re-engineered on an annual basis, as the virus continuously mutates or changes- that’s why a jab is needed every year to maximize chances of being protected. Anyone can get a flu vaccine, but it is more important for some groups who have a higher chance of developing serious complications if they catch influenza- such as the over-65 age group, pregnant women, and people with certain chronic disease such as diabetes and asthma. The government covers the cost of the vaccine if you fall into one of these categories. But unfortunately none of these vaccines gives 100% coverage. And sadly, as yet, nobody has come up with a way to immunise against the 99 types of common cold virus!

With most of the above viral illnesses, the key approach to recovery is adequate fluid intake and rest. If vomiting or diarrhoea is present, over-the-counter oral rehydration solutions such as Hydrolyte are a very good idea-for adults and kids alike. Non-prescription medications such as Imodium can certainly slow down diarrhoea, but are probably best only used now and then rather than continuously, and are not recommended for children. The good old reliables- Paracetamol (Panadol) and Ibuprofen (Nurofen) will help with aches, pains and fevers.

Most people can confidently self-diagnose a common cold or viral gastroenteritis, but if the symptoms seem more severe than expected or if you’re in any doubt, it’s always best to ask a doctor for advice. If you want to avoid sitting in a crowded waiting room, a service such as Dr Sicknote ( www.drsicknote.com.au) can provide medical certificates and carer certificates for work, and will allow you or your loved one to recuperate more efficiently at home, without spreading infection to others. And with any luck, you’ll be back out there, kicking those lovely golden autumn leaves in no time at all!

Absenteeism is a massive cost to Australian employers, and thus to the Australian economy in general. A large survey published by the Australian Industry Group (AIG) in 2015 estimated that absenteeism directly costs organisations $578 per employee per day of absence. In direct costs alone, the loss to economy is said to be in excess of $44 billion per annum. It’s a staggering amount.

On average, Australian employees are taking around ten sick days per year. In the UK, the figure stands at about at around 9 days per year, while in the US it stands at approximately 5 unscheduled days annually per employee.

However, whilst 74% of employers recognised absenteeism as a “significant cost to their business, leading to a considerable risk of competitive disadvantage”, less than 50% had actually taken the step to develop a dedicated policy to manage it.  It’s hard to understand this, when the advantages to employers and employees in having good policy in place are so clear.

But before employers devise a sick leave policy, it’s important to understand some of the reasons why people take sick leave in the first place.  Obviously, the baseline physical and mental health of the workforce is of central importance.  But there are other significant factors.

Previous studies conducted in Australia have shown that certain employees tend to take more sick leave than others. These include workers with primary school-aged children (sick leave rose 20% during school holidays), employees with one child, employees with carer responsibilities, younger employees, union members, contact centre employees, and shift workers.

Those taking the least amount of sick leave were satisfied employees who felt they had a comfortable workplace and a good relationship with their boss, employees with multiple dependents, and higher income earners.

Tackling absenteeism should not be about pitching employer against employee- it is an issue that needs to be addressed in a very holistic way, with everyone on board. Obviously, the overarching culture and morale in a workplace is a fundamental factor.  People need to feel happy, motivated and valued in their role. Certain subgroups may need more targeted support in the workplace, such as increased flexibility in work practices and other measures which acknowledge specific features of their work or home life.

Workplace health programs have been shown to increase productivity and work satisfaction among employees. Typically these initiatives involve a preventive element –with, for example, smoking cessation schemes, personal fitness and healthy eating programs, health education etc.  There also may be elements that provide employees with access to healthcare for chronic conditions, or when they are acutely unwell. Numerous studies show that workplace health schemes have significant benefits for employers – with evidence citing a 27% reduction in sick-leave absenteeism, 26% reduction in health-care costs, 32% reduction in workers’ compensation and disability-management cost claims; and a nearly 6 to 1 return on investment ratio.

With society experiencing a shortage in doctors and the increasing prevalence of new digital health services, companies are now seeking innovative solutions to effectively deliver work place health programs. One-third of large U.S. employers currently offer telehealth and telemedicine services to their employees. With the ongoing rapid development of new apps and remote patient monitoring, it will increasingly be possible to assess, monitor and treat a whole range of medical conditions that previously might have been neglected or even completely undetected due to the inconvenience of taking time off work for medical appointments, or through a simple lack of awareness. If embraced, in the context of a robust workplace health program, innovations like this can ultimately help to deliver a true win-win situation- a reduction in costs to the employer and the economy, and a healthier happier workforce.

Aifric is a vocationally trained GP who practises in an outer suburb of Melbourne. She migrated to Australia in 2014, from Ireland.  She studied medicine at Trinity College Dublin and undertook her specialist training in General Practice in the greater Dublin area. She is married with 2 children. She became part of the Dr Sicknote team in early 2016.

“Common Sense is not so common”

This famous line by the French philosopher Voltaire is often quoted, and many will say it’s quite true. But I would argue that when it comes to minor illnesses, such as the common cold, gastroenteritis or migraine, people, by and large, are well able to exercise common sense and diagnose themselves correctly.  Furthermore, most people are capable of appropriately managing these ailments, whether that involves bed rest, a dose of paracetamol, an increase in fluid intake, or a day off work to recover, and avoid the needless spread of infection in the workplace.

However, at this point, common sense often hits a roadblock. Many workplaces demand a medical certificate for the most minor of ailments, and for very short periods of sick leave. The obligatory visit to the doctor’s surgery involves expense and discomfort for the sick person, whilst potentially promoting spread of infectious disease in the waiting room. An appointment is occupied with the doctor, which might have been better used for a more unwell person. In some respects it also converts the doctor into a rubber-stamping administrator, who is being asked to validate the good judgement of a perfectly intelligent person.

There are wider implications too. The above system may adversely affect how society interacts with the health services, by reinforcing a belief that doctors somehow have a monopoly on medical knowledge. It removes independence and autonomy from the patient and can erode peoples’ confidence to self-care and to appropriately manage their own simple health problems. In most countries, demand for healthcare continues to escalate, with people living longer and ever-increasing levels of chronic disease. It is thus imperative that we find ways to help people to self-manage simple illnesses efficiently and to allocate scarce resources where they are most needed.

Online doctor services are now emerging, and these can enable people to obtain medical care for a wide variety of ailments, as well as providing medical certificates where appropriate. Improving access to reliable online health information is also a challenge. The recently published Australian Child Health Poll, conducted by the Royal Children’s Hospital, discovered that whilst 60% of parents use websites, blogs and online forums to access health information regarding their children, only 6% trusted such sources “a lot” and 36% “did not trust them at all”. In a world where online connectivity is very much a part of daily life, there is surely a place for improved resources to help people safely and confidently access high quality health information as well as trusted medical services that can be appropriately delivered remotely.

Evolution of online healthcare is going to represent a large change to the status quo, and may seem daunting to some. It will engender doubt in certain sectors of the medical and patient community and will challenge traditional attitudes towards healthcare and the very nature of the doctor-patient relationship. But if properly conceptualised, developed and delivered, it could be of huge benefit to society: patients, employers, doctors, and ultimately the taxpayer-as these developments bring scope to significantly reduce healthcare spending.

To quote another wise man, and compatriot of mine , George Bernard Shaw-

“Progress is impossible without change, and those who cannot change their minds cannot change anything”.