Cut to the chase

Sometimes people don’t go to the doctor because they need you to “diagnose” or “prescribe”. They go because they want you to write them a note to get them out of something, somewhere.

When I used to work in primary care, NBD. Generally speaking my patients were adults who, when a note was demanded by a boss or other authority figure, probably should be seeking medical care anyhow, since by then usually they’ve been out longer than one would expect with your basic cold.

In college health, it’s a whole different matter. Professors demand notes all the time; I’m guessing just to make me miserable. Because when note-seeking college students come to see me at the clinic, they present one of two ways:

A) hey, I’ve been kinda sick. These are my symptoms. This is what I’m doing about it. I’m already feeling better – hence why I was able to drag myself out of my dorm room to get here today – but I need a note.


B) I’M PRETTY SURE I’M DYING. I CAN HARDLY BREATHE. OR STAND. OR THINK. I’M 100% POSITIVE THAT MY SURVIVAL IS IN QUESTION. (examination, and/or casual observation by pretty much anyone, discerns that the self-report of symptom severity outpaces the actual medical acuity. By many, many paces.).

After an excessive amount of time is spent “reassuring” the patient that they’re not, in fact, dying, they seem less surprised than you’d expect, given the previous level of concern, to be told they’re going to be fine. And then – usually as a faux “afterthought” – they ask for the note. And suddenly all the drama makes sense.

People. I didn’t buy tickets to see a show when I came into work today. Save the performance for someone else. Like your parents! I bet it works great on them, right? But I just don’t have the time.

Besides, joke’s on you – despite all that effort, we have a no-note policy. Sowwy!

Take home message for my FTs: If you plan on missing a lot of class, pick a college with a clinic that gives notes. And then, when you’re in that appointment: cut to the chase. You can spend the extra time with the clinician chatting about something more interesting, like birth control.


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