Many of the forms are frankly an intrusion into the doctor-patient relationship regardless of who pays for my time in filling them out and I am getting more adept at identifying those and minimizing their intrusion.

My job is to diagnose and treat illness. It is not to mediate negotiations about hours, benefits, responsibilities and leave with an employer, benefit payments with a government or insurance company, or moral repsonsibility with criminal justice authorities or spouses. Playing along with others attempt to displace their difficult decisions onto treating physicians undermines my ability to do my job. It distracts both me and my patient from our joint task, gives the patient an incentive to distort, and moves me from an advocate for my patients health to an arbitor of social justice–leaving me torn often between my sense of obligation to my patient and a concern that I am being used to abuse others financially.

It helps to remind myself that my obligation is not to every interest of the patient–only to diagnose and treat their illness. In all but the most obvious cases, I refer disability requests to physicians who have a focus on doing those evaluations. I can not treat someone’s depression encouraging them to not feel helpless and hopeless while filling out a form that basically certifies that they are indeed, hopeless.