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I felt that the note could be understood as mildly passive aggressive. Maybe adding something like “I have no reason not to believe him/her” would remove any in

I felt that the note could be understood as mildly passive aggressive. Maybe adding something like “I have no reason not to believe him/her” would remove any interpretation that you're writing this note out of obligation but do not believe the patient. Good post btw; I have no input on ethics and would be stumped as well.

netsharc 8y ago
But he does want to help the patient, does he not? But to write something else would be to take the burden of proof into his hands. "Obligation" also makes it sound like he's forced to do it, it's more like without further tests which would inconvenience the patient, he can't be sure the patient is reporting the truth (even with the patient in front of him, he wouldn't be able to objectively observe pain, and he can only ask and believe the answer). But the note fixes the stupid problem of "The rules say no special chairs without a doctor's note"...
- dmurray 8y ago
  I think the "burden of proof" part is exactly what's holding him up. As a skeptic, and an analytically minded person, and perhaps even as a blogger - he's uncomfortable writing "Mr Smith has chronic back pain" without a little more concrete evidence. I'm arguing that as a doctor he shouldn't require more evidence in this case. It's fine to write "Mr Smith has chronic back pain and I recommend he can use his own chair" and be right only 80% of the time, and introduce a process whereby sneaky chair-seeking miscreants can reliably get a doctor's note even if they don't have back pain. It's fine because the consequences of being wrong are extremely low. In practice doctors should be, and often are, OK with making diagnoses of much more serious conditions that are only 80% or 90% or 99% likely to be correct, even when some other test could reduce the uncertainty further. If he's waiting to be 100% certain a patient has bipolar disorder or anorexia before prescribing any treatment, he's doing them a disservice. The level of certainty required should be in line with the severity of the condition being diagnosed, and of the recommended treatment. And when writing a note to an employer, it's correct to say "Mr Smith has cancer" or just "Mr Smith has a medical condition", not "I'm 94% sure Mr Smith has cancer, perhaps the next scan will be more conclusive".
computator 8y ago
Language is so tricky. Adding that extra sentence would make the note more passive aggressive, at least to my ear. Suppose you were looking for a Python programmer, and I sent you these two notes: (1) Joe asked me to put him in touch with you. Joe tells me he has a lot of experience with Python. Here's his email address. (2) Joe asked me to put him in touch with you. Joe tells me he has a lot of experience with Python, and I have no reason not to believe him. Here's his email address. The second one would leave me far more skeptical about the recommendation.

netsharc 8y ago

But he does want to help the patient, does he not? But to write something else would be to take the burden of proof into his hands. "Obligation" also makes it sound like he's forced to do it, it's more like without further tests which would inconvenience the patient, he can't be sure the patient is reporting the truth (even with the patient in front of him, he wouldn't be able to objectively observe pain, and he can only ask and believe the answer). But the note fixes the stupid problem of "The rules say no special chairs without a doctor's note"...

dmurray 8y ago
I think the "burden of proof" part is exactly what's holding him up. As a skeptic, and an analytically minded person, and perhaps even as a blogger - he's uncomfortable writing "Mr Smith has chronic back pain" without a little more concrete evidence. I'm arguing that as a doctor he shouldn't require more evidence in this case. It's fine to write "Mr Smith has chronic back pain and I recommend he can use his own chair" and be right only 80% of the time, and introduce a process whereby sneaky chair-seeking miscreants can reliably get a doctor's note even if they don't have back pain. It's fine because the consequences of being wrong are extremely low. In practice doctors should be, and often are, OK with making diagnoses of much more serious conditions that are only 80% or 90% or 99% likely to be correct, even when some other test could reduce the uncertainty further. If he's waiting to be 100% certain a patient has bipolar disorder or anorexia before prescribing any treatment, he's doing them a disservice. The level of certainty required should be in line with the severity of the condition being diagnosed, and of the recommended treatment. And when writing a note to an employer, it's correct to say "Mr Smith has cancer" or just "Mr Smith has a medical condition", not "I'm 94% sure Mr Smith has cancer, perhaps the next scan will be more conclusive".

computator 8y ago

Language is so tricky. Adding that extra sentence would make the note more passive aggressive, at least to my ear. Suppose you were looking for a Python programmer, and I sent you these two notes: (1) Joe asked me to put him in touch with you. Joe tells me he has a lot of experience with Python. Here's his email address. (2) Joe asked me to put him in touch with you. Joe tells me he has a lot of experience with Python, and I have no reason not to believe him. Here's his email address. The second one would leave me far more skeptical about the recommendation.