Sorry Parents, No More Medical Excuse Notes

Last month, we implemented a new policy stating that we will no longer provide medical excuse notes for patients.

Schools in our community have good policies on record that detail when students should not attend class (e.g. temperature 100^o F or above, vomiting, diarrhea, etc.). While these symptoms indicate that a child may not be well enough to go to school, they do not necessarily warrant a visit to the doctor. Lower-cost care over the phone is sufficient. Ultimately, the parent decides if the child's symptoms necessitate a day off from school. Also, the parent is perfectly capable of writing a note explaining that decision to the school.

Over the years, parents at our primary-care pediatric practice have reported to us that their child's school has made threats (e.g.. not graduating, reporting to the Massachusetts Department of Children and Families, etc.) if their child missed too much school. These parents called us, usually upset or angry, and demanded a note for school to excuse past absences. Before we implemented the policy, we'd simply act as secretary, writing a note for whatever rationale the parent reported as a medical excuse. This was not appropriate.

While most parents are sincere in their decision to keep a child out of school, we've come to learn that a significant number of parents lie about illness, both to the school and to us for the note, to accommodate frequent long ski weekends or multiple long vacations. These parents not only violate school policy and do a disservice to their children, but also waste our office's time. This is why we implemented the new policy. We promoted the policy in our patient newsletter and on our Facebook page. The policy is available on our website and, most importantly, we sent it with a letter of explanation to the school superintendents in our area.

We sent it to the superintendents because we believe the schools' current policy of intimidating families is having the unfortunate effect of having parents send ill children to school and spreading disease to others.

Although school attendance is important, it is also important that patients follow public health guidelines and stay home when they are sick so that they not spread disease to others. At our practice, we believe that all children should attend school, whether public, private, or homeschooled, on a regular basis. When a child misses a lot of school, we encourage our patients to contact us so that we can rule out any treatable physical or behavioral health condition that may be interfering with the child's learning and development.

So far the reaction to our policy has been mostly positive. School superintendents seem to understand the unintended consequences of their policy of intimidation and our parents, we hope, are questioning their choice to have their child miss frequent Fridays to accommodate long weekends in the mountains.

What do you think? Do you provide medical excuse notes? Would you implement a policy like ours?