The nursing director of our operating room had been out of work a lot, gone for two and three weeks at a time, four or five times over the course of a year. There had been enough good reasons: terrible sickness, a number of tragic family problems.
She always seemed to have enough to do when she was at work, but the funny thing was — noted by the 40 or so people who worked in the OR with her — that nothing really changed when she wasn't there. The schedule got done, supplies were ordered, patients had their surgeries and left. When the director retired, the question of replacing her came up. Most of the doctors and nurses agreed: "There's no difference whether she's here or not, and we could sure use the money for more nurses in the rooms." The hospital administration had a different opinion — namely, "Of course we need to fill her post," while offering no real reason why. So we hired another nursing director. She doesn't take much time off and, fortunately, has become useful enough to be missed when she does.
I started musing about this last week, when John McCain dramatically suspended his campaign to return to Washington to do his real job — being a United States Senator. What other job allows you to not show up for work for months at a time without getting in trouble? In Obama's case it's been over a year now since he's worked, but he still gets paid to be Senator. What kind of employer cuts workers that much slack? And what kind of administrative mess must we have in the Senate for there to be no discernible loss of function in the absence of its chief administrators?
As doctors who treat injured folk, we love the self-employed — they'll barely take the afternoon off to have surgery, and one way or another, manage to get back to work that week to keep the business going, get the mortgage paid and feed the family. Even among the salaried folks, we do see a good percentage who take sick-time fairly and responsibly. What a glaring contrast they are to the corporate or government employee whose minor injury keeps him out — but paid — for months at a time. Months during which we are forced to fill out ever more ridiculous disability forms every two weeks.
Docs are routinely called in to adjudicate these matters — to tell the patient that he or she is cured and has to go back to work — when companies want their employees back. But the sad truth is that within our medico-legal system, any doc would be a fool, and a soon-to-be bankrupt fool, if he thinks he can force a patient to return to work against his will.
And, so, we propose to all the companies flailing in this soon-to-be bankrupt economy a "take-away test" to figure out which of your employees you really need. Simply give each worker a nice long vacation — paid, of course (it will be a cost-saver in the long run). Then sit back and see what happens. If your business output suffers and important things go undone, get that employee back. Your company clearly needs him or her. If, on the other hand, you find no discernable fall-off in business, you know what to do: Give him a raise — he's probably a member of the U.S. Senate or the head of a major financial institution. He might throw some fat contracts, or at least a great mortgage, up your way.
Either way, you'll be saving doctors a lot of unnecessary paperwork.
Dr. Scott Haig is an Assistant Clinical Professor of Orthopedic Surgery at Columbia University College of Physicians and Surgeons. He has a private practice in the New York City area.