Odd Work Letter Request by Patient

Career Columnist / Author · Dec 12, 2023

Your concerns are valid, and your thoughts are well laid out.

The employer may be requesting a note as a condition of employment, which may or may not be legal. Regardless of the reason, the request is inappropriate and shifts all liability to you.

Your role as a healthcare provider is to prioritize the patient's health and well-being. Assessing your patient's job performance is outside of your scope.

Discuss your concerns with the patient openly. Let them know that you cannot evaluate their job performance as it is the responsibility of their work supervisor.

You could also check with your insurance carrier and your employer's legal counsel.

sleepwalker, MSN, NP · Dec 18, 2023

Here's a potential twist on the request...

Did the patient decide to stop taking the medication on their own or did you mutually decide to taper the patient off the medication or cease the medication with medical oversight? Employer may be looking to find out how and why the medication was stopped.

If you and the pt agreed to stop the medication just say that and indicate that there is no reason for the patient to be on a medication that is no longer warranted from pt and/or medical perspective.

I'd also throw in a quick statement saying something along the lines of onsite work evaluation regarding work performance is beyond the scope of a medical practitioner and remain the responsibility of the employer.

FullGlass, BSN, MSN, NP · Dec 18, 2023

sleepwalker said:

Here's a potential twist on the request...

Did the patient decide to stop taking the medication on their own or did you mutually decide to taper the patient off the medication or cease the medication with medical oversight? Employer may be looking to find out how and why the medication was stopped.

If you and the pt agreed to stop the medication just say that and indicate that there is no reason for the patient to be on a medication that is no longer warranted from pt and/or medical perspective.

I'd also throw in a quick statement saying something along the lines of onsite work evaluation regarding work performance is beyond the scope of a medical practitioner and remain the responsibility of the employer.

Good points - thank you.

Patient decided to stop taking medication on their own. I think something else is going on with them because they were desperate to get ADHD treatment and told me that it was very helpful. For scheduling reasons, the patient then saw other providers for a couple of months and then I got the letter request out of the blue. The patient said they could no longer take ADHD meds because of their "line of work." The patient is a bartender, unless they made a drastic career change, and that just does not make sense. That is why I think there is something else going on.

I told our document staff to just write letter stating pt is no longer taking X medication. We do not have the ability to monitor patient's work performance, blah, blah.

CuriousConundrum · Feb 1

FullGlass said:

Received a rather odd letter request from a patient today. We are all used to writing letters such as the patient needs time off, they are safe to do their jobs while taking their prescription meds, etc. This one threw me for a loop, though.

This pt has ADHD and decided to stop taking their ADHD med. Their work wanted a letter from me stating the pt can do their job fine w/o their ADHD med. I'm not sure I want to do this because:

1. I do not personally supervise the pt's work and have no idea if they would be OK doing their job w/o their ADHD med

2. It is the job of the pt's work supervisor to determine their work competence

3. This seems like a potential liability issue. As an extreme example, let's say this pt is an Air Traffic Controller and has ADHD. Clearly, if the pt goes off their ADHD med, and an accident occurs, the results can be disastrous, with many lives lost. If I certified their fitness for work w/o their ADHD med, then I could be sued.

Anyone run into a similar situation or have thoughts on this?

I thought ATCs had to be examined by AMEs (aviation medical examiners) as pilots do. This would be something to kick back to them. For the pilots, ADHD is a 100% no go. Frankly, I think for ATCs it's even more of a problem.

On another note, I don't write letters. I tell them, "get a copy of this progress report" to validate whatever their concern is. Letters take personal time and are not reimbursed.

FullGlass, BSN, MSN, NP · Feb 1

CuriousConundrum said:

I thought ATCs had to be examined by AMEs (aviation medical examiners) as pilots do. This would be something to kick back to them. For the pilots, ADHD is a 100% no go. Frankly, I think for ATCs it's even more of a problem.

On another note, I don't write letters. I tell them, "get a copy of this progress report" to validate whatever their concern is. Letters take personal time and are not reimbursed.

Writing some letters and completing some forms, like disability applications, are part of our job as providers. At my first primary care job, all providers were expected to do this and we weren't paid for it. For simple letters, like the pt is off work because they had an appointment, the M.A. did those.

At my current employer, we have Document Services Dept and the patients pay a small fee for letters, forms, etc. However, providers still have to review and sign these and for more complicated matters, have to do some writing.

I view this as part of my job because I truly care about helping my patients.

Most of these letters are "form letters" and once a template is created, they are quick and easy to generate. If my Doc Svc Dept is unavailable, I can do a letter in 5 minutes.

It is completely inappropriate to just tell pts to give someone a copy of the progress note. That is HIPAA-protected information!

Being a provider is not a 9 to 5 job. I don't mind putting in a little extra time. Any professional does that in any profession.

JKL33 · Feb 7

FullGlass said:

However, providers still have to review and sign these and for more complicated matters, have to do some writing.

I view this as part of my job because I truly care about helping my patients.

Agree that it is part of the job.

I require office visit for the more burdensome requests.

Snowranger19, MSN, APRN · Feb 7

If the patient is a bartender, is it possible he is being drug-tested or having an issue due to taking a stimulant? Not sure what medication he is on (I would assume some stimulant) but I have had patients with concerns about work due to random drug testing or an addiction issue occurring.

I agree with others, talk to the patient about WHY and I would also ask why the letter is being requested and by whom. I would share I don't have enough information to be comfortable writing such a letter unless I knew specifics and even then, the letter may not say what they want it to say.

-Snow

FullGlass, BSN, MSN, NP · Feb 8

Snowranger19 said:

If the patient is a bartender, is it possible he is being drug-tested or having an issue due to taking a stimulant? Not sure what medication he is on (I would assume some stimulant) but I have had patients with concerns about work due to random drug testing or an addiction issue occurring.

I agree with others, talk to the patient about WHY and I would also ask why the letter is being requested and by whom. I would share I don't have enough information to be comfortable writing such a letter unless I knew specifics and even then, the letter may not say what they want it to say.

-Snow

We just wrote a letter stating the pt has been seen here from start date to end date. They are no longer a pt and we are no longer prescribing medication.

There really is nothing else we can say. It is not the provider's job to evaluate a pt's work performance - it is the employer's job. And there is no way a provider could do that, anyway. We don't go to work with the pt. This pt was a bartender. They then decided to become a pilot. Pilots are not allowed to take ADHD meds. Given the pt has ADHD, I think they are deluded, frankly. I seriously doubt they will be able to earn a pilot's license with uncontrolled ADHD. I'm not sure if the FAA will require medical records. If they do, they likely will frown on a potential pilot with ADHD, for obvious safety reasons. I'm not an expert in aviation stuff.

CuriousConundrum · Mar 11

FullGlass said:

It is completely inappropriate to just tell pts to give someone a copy of the progress note. That is HIPAA-protected information!

Being a provider is not a 9 to 5 job. I don't mind putting in a little extra time. Any professional does that in any profession.

I disagree. You wouldn't be telling them what to do with the note. That's on them. I just tell them I'll include that documentation, and they disseminate it however they choose. We won't send it anywhere without a release.

I do mind putting in a little extra time because I work to live. I don't live to work. I dedicate very specific blocks of time to the career. A decade later, this is where I'm at. I have boundaries and provide very specific services and outside that realm, I won't do it.

FullGlass, BSN, MSN, NP · Mar 11

CuriousConundrum said:

I disagree. You wouldn't be telling them what to do with the note. That's on them. I just tell them I'll include that documentation, and they disseminate it however they choose. We won't send it anywhere without a release.

I do mind putting in a little extra time because I work to live. I don't live to work. I dedicate very specific blocks of time to the career. A decade later, this is where I'm at. I have boundaries and provide very specific services and outside that realm, I won't do it.

I must disagree.

1. As highly paid professionals, we do not have a 9 to 5 job. Sorry, but that is the brutal truth. Other professionals, like doctors, business people, lawyers, and accountants do not work just 9 to 5. While I do not work tons of overtime, I don't mind putting in 20-30 minutes extra per day. I used to be a business executive and regularly worked 9-12 hour days 5 days a week, plus I put in some time over the weekend. And that does not include my travel time (had to travel a lot).

2. We should be cautious with chart notes. Yes, the patient can do what they want with their medical records, but patients may not be aware of why caution is needed.

I probably work 2-3 hours extra per work total. I have literally had patients cry tears of joy from my efforts to "go the extra mile" for them. That is worth it to me.

FullGlass, BSN, MSN, NP · Mar 11

CuriousConundrum said:

I do mind putting in a little extra time because I work to live. I don't live to work. I dedicate very specific blocks of time to the career. A decade later, this is where I'm at. I have boundaries and provide very specific services and outside that realm, I won't do it.

Just want to add that many NPs on this forum have complained they want to be paid more. It seems unfair that their appts are reimbursed at almost the same rate as MDs, but NPs make a lot less.

MDs work their behinds off. All the MDs I know put in a lot of extra time. If NPs want to be paid at a higher rate compared to MDs, then they must demonstrate a commitment that goes beyond "9 to 5." Most NPs do this, so I am not criticizing NPs in general.

NPs can't have it both ways. If they want to be viewed as providers that just work their 8 hours and no more, then they deserve to be viewed as "less" than MDs in terms of quality of care.