Dealing with Requests for Sick Notes

The Chief Provincial Public Health Officer, Dr. Brent Roussin, has advised that employers should encourage employees to stay home when ill ​“without facing barriers such as the requirement for sick notes” (March 12 news release).

Doctors Manitoba has produced a sample letter for patients to provide to employers regarding sick notes, which clinics can adapt to meet their needs.

Mask Exemption Requests (Updated Aug. 27, 2020)

With masks becoming mandatory in different settings or regions in Manitoba, physicians are receiving requests from patients seeking to be exempt from this requirement.

The College of Physicians and Surgeons of Manitoba has provided practice guidance to physicians, reminding physicians that providing medical notes is considered part of providing medical care and, as such, must adhere to their standards of practice.

With regards to providing a medical note exempting a patient from required mask use, CPSM advises physicians to:

• Provide patients with appropriate education and guidance consistent with Manitoba public health guidelines
• Only provide an exemption if there is a justified medical condition that supports the request
• Document the reasons for granting/​refusing a mask exemption in the patient’s medical record
• Stay up to date with recommendations from Shared Health and Public Health regarding appropriate circumstances for an exemption.

The current circumstances listed by public health to support an exemption include:

• A person with a medical condition unrelated to COVID-19 including breathing or cognitive difficulties or a disability, which prevent them from safely wearing a mask
• A person who is unable to put on or remove a mask without the assistance of another person.
• Children under 5 years of age (under two when visiting a health facility, and grades 4 or lower in school)

Workplace or School Accommodation Requests (Updated Aug. 27, 2020)

As more services reopen, we have heard reports that more patients are calling the doctors for sick notes. Several physicians have raised concerns that some of these requests are arising from employees who are fearful of catching COVID-19 at work or bringing it home to their families. You should consider the following when faced with sick note requests for workplace or school accommodations or absences:

• Ensure your patient has a good understanding of COVID-19, its risks and has clear and complete information from their employers about precautions.
• If a patient is requesting an accommodation at, or absence from, the workplace or school because they believe they are at increased risk, you may choose to provide a note. However, unless you are aware of your patient’s working or school conditions, it may be very difficult to draw a conclusion that a return to the workplace is not appropriate. Different employers may require different information to understand the cause of the limitation or restriction to help assess if additional precautions or changes are needed. Review the provincial guidance for a list of risk factors, including age, pregnancy and specific medical conditions.
• If your patient reports a new condition – including anxiety or other mental health condition exacerbated by a return to the workplace – it is entirely reasonable to require an in-person or virtual visit before you can draw any conclusions, and ensure your patient has credible information about COVID-19 and has details from their employer about the precautions they are putting in place. 
• It can also be difficult to respond to patients requesting sick notes because of other issues, such as child care or transportation challenges, or because of family members’ health concerns. These are all valid concerns, but are problematic to use as medical rationale for sick notes.

CPSM has provided guidance on responding to requests from parents to excuse their child from attending school in person. Physicians should provide education and guidance to parents, have an informed conversation about risks and
assess whether their child has a medical condition that increases risk of COVID-19 infection or may place them at a higher risk of death if they contract the virus.

Sick Note Requests from Health Care Workers

• Shared Health has also issued guidance regarding medical notes for employee accommodation requests from health care workers.
• The full Shared Health memo to health care workers offers an overview of the position that provincial occupational health has the final say on assessing and approving exceptions from the workplace for health care providers, but relies on medical assessments of patients’ physicians in that process.