Time off work

I disagree with Dr Karazivan admonishing the resident for not giving the patient the 3 weeks off work that the patient requested in the May Cover Story, “Thinking like a rebel.”¹ Refusing a patient’s request for time off from work has nothing to do with systemic power, inequities, or capitalism, as Dr Karazivan suggests. In fact, refusing a request for time off from work, in the absence of evidence to support the need for time off, is practising good medicine.

The Choosing Wisely Canada occupational medicine recommendation 1 is “Don’t endorse clinically unnecessary absence from work.”² The rationale for the recommendation includes the “substantial evidence to support the positive link between work and health (physical, mental and social health).”² Absence from work slows recovery and prolongs disability. Rather than giving time off the work, the physician should give restrictions that are “objective, specific, and listed only when absolutely medically indicated.”²

Dr Karazivan asks who is winning by not granting a patient 3 weeks off work if that’s what he or she is asking for. He concludes that the patient’s boss is winning. In fact, by not granting 3 weeks off from work, the patient is winning.

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