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Wisconsin's Real Doctors and Their Fake Sick Notes for Protesters

Feb 21 2011, 7:50 AM ET By Ford Vox 229

Fears over becoming hostage to soaring health insurance premiums has Wisconsin's teachers and other public employees protesting in downtown Madison for the second week running. It's a very real threat to their economic stability, one they'll be ill-equipped to tackle without the unionizing rights proposed legislation would deny them.

No doubt many members of the University of Wisconsin's Department of Family Medicine share the teachers' concerns. Public employees are joining a struggle already familiar to most patients. Family doctors work the front lines advocating for our interests amidst a disintegrating health care system, summoning the will to keep battling with insurers and administrators all while trying to hold on to their belief that they can change human behavior. Family doctors feel your pain and have the battle scars to prove it.

But last week some of these weary warriors carried their patient advocacy too far. In videos breathlessly presented throughout the conservative mediasphere this weekend [scroll down to see], doctor after doctor is videotaped writing patently fraudulent sick notes so that the protesting teachers (whose contracts specify that missing work without an excuse can result in dismissal) can keep marching on against the state's union-busting Republican government.

After viewing the videos at my request last night, Dr. Arthur Derse called me up exclaiming, "Holy mackerel! It's much worse than it looked in the paper. I'm stunned, absolutely stunned." Dr. Derse is the Director of Center for Bioethics and Medical Humanities a the Medical College of Wisconsin. "When all's said and done, it's really the profession of medicine that has the black eye in this case," he says.

There is no question these doctors are masking political opinion in the white coat of the medical profession, Dr. Derse believes. "The videos are pretty damning."

It's sad, but what puzzles me most is how in the world three of the four physicians I can identify from these videos and other media reports are faculty members of UW's Family Medicine department, and one is a senior resident in that same department. It's a good training program, committed to providing sorely-needed primary care doctors to the state of Wisconsin. It teaches professionalism, and its faculty are supposed to model integrity. What were they thinking?

They've managed to belittle a public trust between physicians, employers and patients. A doctor's sick note is a serious document. It represents an employer's desire to verify through a respected, independent, medically qualified third party the fact of an illness and the true need for convalescence. In the videos now circulating online, we witness multiple members of a noted family medicine department trash one of the well-recognized rights and privileges of their profession, with little forethought as to the consequences.

UW's doctors have demeaned not only the doctor-patient relationship, but in so doing, risked the stature doctors hold in our discourse on public policy. When commenting on social issues, physicians trade on the honor of our profession, benefiting from the public's assumption that the wisdom won of caring for so many at their most vulnerable imbues us with some privileged understanding of collective need.

In one of the videos and a newspaper account, Associate Professor Lou Sanner says he's giving out sick notes for "stress" (not a medical diagnosis). He claims he's forming doctor-patient relationships in his slapdash street encounters with apparently healthy protesters. Besides his work in bioethics, Dr. Derse is an emergency physician, regularly tasked with determining fitness for work. He's offended by Dr. Sanner's thin claims. "I couldn't imagine just walking up to people with a stack of work excuses, 'What's your name? Here you go.' ... It reflects poorly on the practice of medicine, and it reflects poorly on physicians who actually do take the time and effort try to determine whether someone is ill and is legitimately away from work," he adds.

These doctors sacrificed a slice of the medical profession's credibility for a political cause. Was it worth it? The fallout is mounting.

After declining to make an administrator available for comment, a public affairs representative
for the University of Wisconsin read the following statement:

It has been reported by some local news media that some protesters at Capitol Square in Madison, Wisconsin have received medical excuse notes from physicians associated with UW Health. While we cannot confirm this event, physicians who may be distributing such material are doing so of their own accord and do not represent UW Health on this issue. We are looking further into this matter.

There's little left to confirm. I expect we will be hearing more from UW this week. UW's unwitting family doctors were swarmed by enterprising conservative videographers who know an O'Keefe moment when it slaps them upside the head. They handily outmaneuvered their naïve prey, succeeding in recording every foible. The videos, including an especially uncomfortable one featuring resident Dr. Patrick McKenna (son of a teacher!), make their intentions transparent and reveal they didn't think too far ahead.

When they did stay on it message, it wasn't much to behold. One of the unidentified young physicians tells an inquisitive local libertarian organization called the MacIver Institute, "We are here writing doctor's notes to support our public employees who have been mentally anguished and distressed this last week and needed to be out here for their mental health." Medically speaking, that's comedy.

Elsewhere in the tape UW faculty member Dr. James Shropshire signs a fake sick note for the MacIver videographer, who tells him he's from California and isn't tolerating the cold Wisconsin weather so well. Dr. Shropshire responds flatly, "So I'm concerned about that. I'd like you to take the rest of the day off today, get some rest, and try to stay healthy," and signs his excuse note.

I discussed what happens next with Dr. Tim Bartholow, Senior Vice President for policy, membership and professional development at the Wisconsin Medical Society. "We do know that our medical examining board is aware, and I think they need to be aware," he says. "I don't think our medical board will be reluctant to respond if they find misrepresentation."

I expect forthcoming complaints will center around this idea of fraudulent representation (and come from folks with obvious political agendas). Theoretically a school board official could make a complaint that their organization was financially harmed (many schools had to close due to the number of teachers at the protests, and some may have received pay on sick days). I'll wager any complaining school board official will be a registered Republican.
Personally I think suspension or revocation of medical licenses would be quite a disproportionate response to the actual harm involved in this high-profile infraction of professional ethics.

The lasting damage is medicine's tarnished public image, and it is in that context that the Wisconsin Medical Society should craft a swift response. As is the case in every state, medical societies represent professional interests and are separate institutions from the medical boards responsible for issuing licenses. Societies accept members in good standing with the boards. In the two years Dr. Bartholow has worked for Wisconsin's medical society, his organization has never had to issue a position statement on a particular case. That silent streak probably ends now, given that the body is charged with representing Wisconsin's doctors to its citizens and its government. 

"I think the physicians were seeking to support individually an action that they thought was important, but there are probably going to be some discussions about whether that comports fully with the patient-physician relationship," Dr. Bartholow says.

I've requested interviews with the four UW physicians I could identify and hope to share their side here with you.

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In trying to unravel this relationship, scientists concluded that perhaps living farther away from the equator might relate to MS risk because of a lack of sunshine. It is known that sunshine has a role to play in immune function, so scientists thought that perhaps a lack of sun exposure during winter made people more susceptible to the disease. But one other connection to sun exposure began to emerge. It is known that one of the key physiological events triggered by sun exposure is the body's production of vitamin D. Interestingly, research clearly demonstrated that MS patients have remarkably lower levels of vitamin D compared to non-afflicted individuals.

NOTE: Vitamin D can be toxic in large doses. People with MS should be aware of these findings, but should also discuss them with their neurologist.

These findings dovetailed nicely with the newly emerging reports expanding the understanding of the role of vitamin D in human physiology, not just for bone health, but as a key player in immune function as well. To put the idea of vitamin D's relationship to MS to the test, researchers in Toronto -- led by Jodie Burton, M.D. -- studied 49 MS patients for one year. Twenty-five of the patients received vitamin D in a dosage increasing up to 40,000 units daily, which was then reduced over the one-year period. The control group was given no vitamin D supplementation.

The results of their study, published in a recent issue of the journal Neurology, were astounding. The group receiving the vitamin D demonstrated a remarkable 41 percent reduction in new MS events, a figure that markedly exceeds what is claimed by the standard drug treatment discussed above. What's more, the treatment group actually demonstrated improvement in physical function, a finding not seen in the control group.There were no meaningful side effects in the group receiving the vitamin D treatment and researchers demonstrated that blood calcium levels remained perfectly normal throughout the test, even at the very highest dosages of vitamin D. This was an important part of the study since concern has been raised that high vitamin D levels might increase blood calcium levels. The authors reported:

We have demonstrated that vitamin D intake well above current recommendations and (vitamin D) levels well beyond the physiologic range, do not expose patients with MS to adverse biochemical or clinical events. Compared to a control group whose intake of vitamin D generally exceeded North American recommendations, only those on the treatment regimen had evidence of immunologic effects.

As a practicing neurologist actively treating patients with this sometimes-devastating disease, this new report has clearly offered a potentially new and powerful tool for my toolbox. Vitamin D is incredibly inexpensive, and, according to this report, safe and powerfully effective as well. Clearly we will need to see more research to confirm these findings, but what a breath of fresh air it is that such a wonderful gift might be available at the health food store, or even from the good old sun itself.

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