June 2023. Richmond Hill, NY. Monday morning. I pressed the bell for the next patient and a pretty young lady breezed in. As soon as we finished exchanging greetings, and she had hardly taken her seat, my cell phone went off, as if on cue. I hated it. But a quick glance at the Caller ID convinced me that this is a call I had to take: “Electronic Medical Records Support”.
I apologized to my patient and picked the call. Our Electronic Medical Records were upgraded a week earlier, with more enhanced features. It was a lot more complex than what we had and we got lost easily navigating our way. We did not know where to access the functions we were used to, everything was different. I called for support the prior week.
I hated the idea that they called me back on Monday morning, my busiest day of the week, but I had no choice. We had worked under a restraining handicap with the new system for a few days. I gave the remote connection on my computer to the technician and he worked me through, on my shared desktop screen, showing me many of the new features, and where to find our old familiar functions.
The support exercise took forever. Now and then I would cast a glance at the patient, seated to the left of my desk. She sat calmly, well composed, not displaying any signs of impatience typical of many of our patients in similar circumstances. She gently surfed the web on her cell phone.
About fifteen minutes later, the technician was done. A few problems remained but most of the big ones have been resolved. I broke off the support connection and faced the patient with a smile, apologizing profusely. I thanked her for her grace and patience. “What can I do for you today?”, I asked her finally.
“Doctor, I want you to certify that I am fit to work”, she calmly explained. I quickly scanned her from head to toe — no sign of any injuries. That was puzzling. Certification of fitness to work is usually required after an injury or an accident, especially on the job. I did not see any of those with this patient. So I asked her: “Who said you cannot work?”
“The Medical Examiner at my job said I am unfit to work unless I bring a note from my doctor stating otherwise”, she explained. By this time I have had the opportunity to peruse her medical records with us. It showed that her last visit was in March 2022. At that visit, I had diagnosed her with Dysthymic disorder, with both anxiety and depression. I started her on sertraline and asked her to follow up with me in one month. She never showed up. I am not sure if she ever took the medication.
I asked to see the Medical Examiner’s report from her job. She brought out a long folder with typed sheets of paper. The medical examiner outlined the background complaints from the patient’s coworkers, and his own interview with her. He concluded that she was unfit to continue on the job, a very drastic conclusion.
She was very eager for me to issue her clearance there and then, because, in her opinion, there was nothing wrong with her. Confronted with the weighty complaints of her aggressive and confrontational behavior at work, and the conclusions of the ME who had investigated the matter, I felt that it was inappropriate for me to issue her a clearance after a cursory interview and assessment for only a few minutes.
I faced her directly, and in a low voice explained to her that I considered the morning’s assessment inadequate and that I felt that we needed more information, before we issue a clearance of fitness to work. Therefore, since I was unable to complete the assessment, I would be referring her to a psychiatrist. I told her that the psychiatrist could issue the clearance, or she could bring me a report from the psychiatrist, stating that she was ok to work, on which I could depend to issue the clearance myself.
All hell broke loose. The woman who had calmly interacted with me all morning suddenly became volatile and aggressive. She wondered why I needed a psychiatrist. Was I not a trained medical doctor? Was I not competent to issue such a report?
I tried to reason with her. Yes, I am a trained doctor. Yes, I am competent to write such reports. However, there is something about this case that makes me pause, err on the side of caution, and get a proper assessment and evaluation before drawing a conclusion. It is a matter of discretion, but I felt uncomfortable drawing a conclusion that she was fit to work just yet: I needed more information!
The tigress bared her claws and went after me. By this time she was yelling. “What do you mean that you are not a psychiatrist? Did you not prescribe psychiatrist drugs for me last year? That means that you were engaged in medical malpractice last year! You are not a psychiatrist but prescribing psychiatrist medication!” She went on and on.
By this time I was fed up with this case. First, there was a delay caused by our technical support. Then this strange woman insisting that I declare that she was normal and fit to report to work, despite all indications pointing to the contrary.
“Madam, I need to go. I need to attend to other patients waiting. I have prepared your referral to the psychiatrist. They will print it for you at the desk”. At this, she exploded and lost it completely. “What type of doctor is this? Cannot issue simple certification for work? And engaging in the practice of psychiatry”. Blah blah blah.
I finally lost my patience with her. I told her there was no way that I was going to certify her that she was fit to work. That as a matter of fact, based on her conduct that morning, it was my considered opinion that SHE WAS NOT FIT TO WORK. She stormed out of my office seething with rage. I don’t even recall whether she picked up the psychiatrist referral or not.
A very strange woman. Usually when people insist that they are “normal”, it usually means that they are not. She obviously needed the psychiatrist in the worst possible way. Not for certification for return to work, but for proper assessment, diagnosis, and treatment. If you ask my opinion, this lady has schizoaffective disorder and needs to have treatment with an atypical antipsychotic medication, psychotherapy, or preferably, both!
Emmanuel O. Fashakin, M.D., FMCS(Nig), FWACS, FRCS(Ed), FAAFP, Esq.
Attorney at Law & Medical Director,
Abbydek Family Medical Practice, P.C.
Web address: http://www.abbydek.com
Cell phone: +1-347-217-6175
“Primum non nocere”
