My patient looked a little apprehensive that I might bite her head off and demurely asked, “Doctor, will you fill out my Family Medical Leave Act form?”
No one in their right mind is ever happy about getting extra paperwork from the federal government, but FMLA forms are all pretty much the same, and generally don’t take too long to fill out.
Dr. Larry Greenbaum
Physical-capacity evaluations are a different situation entirely. These forms are usually sent by the attorneys of patients who seek disability. They take a long time and put a real crimp in my schedule, but I’ll leave that pet peeve for a different column.
“Fine,” I said, with as much fake enthusiasm as I could muster, “it isn’t that big a deal.”
“Oh thank you, doctor!” exclaimed my grateful patient. “I asked my family doctor to fill it out and he said, ‘I don’t want to see another f***ing FMLA form!’?”
I was taken aback. My colleague had, until now, always sported a temperate disposition. What could the government have done to have brought my beloved referring physician to utter an obscenity?
A long time ago, a medical school professor explained that it was the consultant who ended up with the responsibility of doing the patient’s rectal exam. This is the same concept in a new guise: It is the consultant who is stuck with the FMLA form.
In case you think I am exaggerating, I sometimes see new patients and the first thing out of their mouths is how badly they need their FMLA form, but their family doctor refused to fill it out. One family doctor bluntly wrote in the progress notes of a patient with fibromyalgia that he would not fill out an FMLA form, but he would try to get the patient an appointment with a rheumatologist ASAP. Until that moment, I had never realized that filling out FMLA paperwork constituted a medical emergency.
The FMLA is really a simple concept: Patients or caregivers who need time off work for medical issues should be allowed to take unpaid leave without losing their jobs. One patient told me that if he had three absences from work in a year he’d lose his job unless he had documentation that he’d been in the hospital, that he’d been at a funeral (not his own), or that he had an FMLA form. How could such a simple idea become so complicated?
One thing that annoys me is filling out the same form for the same patient with the same diagnosis over and over and over. I often get the idea that somewhere deep in the bowels of corporate management, someone came up with a passive-aggressive policy of repetition and attrition to wear out the wills of patients (and their physicians) who were trying to take off time to which they were legally entitled.
I told one of my stable FMLA patients to schedule a 4-month follow-up appointment. She explained that her work wouldn’t honor her FMLA unless she had a new form filled out every 2 months. I nobly volunteered to fill it out in 2 months’ time and have her return to see me in 4 months. She was apologetic, but said that her job insisted that she had to be reevaluated by the doctor every 2 months. And people wonder why health care is so expensive in the United States! I wonder if patients in other countries are required to have extra visits just to fill out FMLA forms.
I have compensated for this bureaucratic madness to some extent by keeping copies of all FMLA forms in the chart. If a patient has had an FMLA form previously, the nurse fills out the new form exactly like the old form, fills in the correct date, and all I have to do is sign my name. This helps to keep the paperwork at a relatively painless level.
FMLA forms usually ask in what way the applicant qualifies for an FMLA leave. There are usually six categories. Most of my patients are in category 4, which indicates a chronic medical condition requiring follow-up care. Pregnancy is another category, but that is almost never an issue for my rheumatology FMLA patients.
The most difficult question is how much time off work I think the patient will need. In other words, I need to gaze deep into my crystal ball (or my electronic medical records computer screen) and predict how many hours, days, or weeks my patient will be absent because of a flare of their chronic condition. How am I supposed to know? If I could predict the future as well as the federal government thinks I can, I could have become a successful day trader.