Medical Excuse Policy
Time for a new prescription?
ACHA
June 4, 2010
Janet Corson-Rikert, MD Cornell
John Kolligian, PhD Princeton
Bill Purdy, MD Duke
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Medical Excuse Policy
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Introductions
The Game
Player perspectives
Issues / problems
Three institutional approaches
Conversation with the audience
Potential next steps
Cornell University
Ithaca, New York
• 21,000 students, 13,000 undergraduate
• Slightly < 50% of undergrads live on
campus
• Seven undergraduate colleges with
separate admissions, policies and
procedures
• No university-wide honor code
• UHS reports to VP Student and
Academic Services
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Duke University
Durham, North Carolina
• 13,000 students, 6500 undergraduate
• Freshmen through juniors live on campus
• Two undergraduate
colleges
• Honor code
• SHS has dual report
to Dept of Pediatrics and
Student Affairs
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Princeton University
Princeton, New Jersey
• 7500 students, 5000 undergraduate
• All students live on campus
• Two undergraduate colleges,
consistent policies/procedures
• Honor code focuses on
in-class exams and written work
• UHS reports to Vice President for
Campus Life
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What is the game?
Jumping Through the Hoops,
as played at Duke
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Christmas, W., Journal of American
College Health, Vol. 46, 1998
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What’s the problem?
• Each college / university culture is unique
• Game varies, but in all
– SHS plays an unwanted and inappropriate role
– goal that is not accomplished
• Each player has a different perspective
– Faculty, deans, students, SHS
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Faculty perspective
• Students use excuses to manipulate / gain
advantage
• Fabricated excuses create
• Unfairness
• More work for faculty
• Medical excuses especially difficult
– Not qualified to judge veracity
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Dean’s perspective
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Need to be involved to administer process
Take burden off individual faculty members
Able to maintain objectivity
In a position to identify patterns of abuse
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Student perspective
• Students with legitimate illness
– Feel implicit distrust from faculty
– May be coerced into sharing health records
– Are ‘caught in the middle’
• Students who are manipulating the system
– Learn that it’s easy to dupe providers
– Are rewarded for creative deception
• Students not using the system at all
– May be disadvantaged
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SHS perspective
• Difficult to confirm legitimacy of excuses
– After the fact
– If no objective tests
– When test results don’t correlate with disability
• Providers are patient advocates
– Unlikely to question history
– Should not facilitate use of faculty
power/authority to pressure students to share
private information
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SHS perspective
• Fabricated history contaminates
– Medical record
– Relationship with provider
• Displace medically appropriate visits
• Entire process adds no value
– Records same story as would have been
provided to faculty member
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Why care about this issue
• Implications of this issue on student
development
– Emerging sense of self, authenticity, and
integrity
– Forging new relationships with important
others
– Identifying with institutional values and
aspirations
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Implications for
Student Development
• Fabricated illness
– Reinforces student dishonesty, and
promotes a system that sustains untruths
– Injects disingenuousness, even disrespect,
into the health care relationship
– Complicates developing identities and civic
values
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Implications for
Student Development
• Legitimate illness
– Implies mistrust, risks character insult,
undermining faculty contacts
– Creates pressure to disclose private
information, tainting health-related
contacts
– Discourages independence and mature
reliance by promoting such contacts
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Mental Health-Related Excuses
• Complications of excuses sought for
psychological reasons
– Stigma about mental health
– Burden of invisible illnesses, and
differences in excuse credibility
– Role of physical and behavioral
symptoms
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Summary of Concerns
• The medical excuse process
– Disrespects students and right to privacy
– Lowers expectations for adult behavior and
citizenship
– Creates a formal system for sustaining
dishonesty
– Creates burden for health services staff
– Teaches inappropriate use of health care
– Replaces more effective approaches to
addressing academic integrity
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Institutional approaches
• Compromise through a verification of visit
approach (e.g., Princeton)
• Appeal to honor code and institute a new
process (e.g., Duke)
• Get out of the business (e.g., Cornell)
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Princeton Experience
• For deans and faculty—notes generally
seen as essential, honor code as
inapplicable
• Excuse notes modified to verification of
visit notes in 2004
• Discontent at UHS’s suspension of notes
in fall 2009, as per CDC H1N1 guidelines
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Duke Experience
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Duke Student Health
The student listed below came into Student Health today and asked us to notify
his/her dean:
Name:_____________________________________________________
Duke Unique #______________________________________________
Date: December _________, 2009
Signed: ________________________________________________
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Notification of a Student Visit to a Health Care Provider
During the Final Exam Period
FOR THE STUDENT:
Only your academic dean may authorize an absence from a final exam. Before
evaluating your request to be excused from a final exam because of incapacitating
illness, your academic dean requests that you be seen by a health care provider.
Please initial and sign this form as indicated below and obtain the signature of a
health care provider. You may either return this form to your academic dean’s
office or ask your health care provider to fax this form to the number indicated
below.
____ (Student initials). I’ve received this form from my academic dean because
I’ve stated that I have an incapacitating illness that renders me unable to take my
final exam.
____(Student initials). I understand that for my own safety, I must see a private
health care provider or someone in Duke Student Health or CAPS as soon as
possible.
____(Student initials). I give permission to my health care provider to
communicate information to my academic dean about my health care visit as it
pertains to the dean’s decision to authorize an absence from a final exam.
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___ (Student initials). I am aware that in submitting this form, I am bound by the
Duke Community Standard. I pledge that I will not obtain information of any kind
that will provide me with an unfair advantage over other students taking the final
exam.
Student Signature:____________________________ Date:
__________________
FOR THE HEALTH CARE PROVIDER:
This student was seen in (please circle): a) Student Health b) CAPS c) Private
Office d) Other on (date) ______________ by (please print name)
____________________________________.
If you need to contact me, the best way to reach me is by calling
_________________________or sending an e-mail to ___________________.
Health Care Provider Signature:_______________________ Date: ___________
PLEASE FAX THIS FORM WITHIN 24 HOURS TO 919-684-4515 (a different
form will be made for the West Camps deans with their fax number)
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The Duke Community Standard
Duke University is a community dedicated to scholarship, leadership,
and service and to the principles of honesty, fairness, respect, and
accountability. Citizens of this community commit to reflect upon and
uphold these principles in all academic and non-academic endeavors,
and to protect and promote a culture of integrity.
To uphold the Duke Community Standard:
•I will not lie, cheat, or steal in academic endeavors;
•I will conduct myself honorably in all my endeavors; and
•I will act if the Standard is compromised.
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Cornell Experience
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Cornell Experience
• 2004
– Dean of the Faculty
– Executive Committee Campus Health
– University Assembly discussion
– Derailed by discussion of honor code
• 2009
– Created H1N1-related policy, then generalized
– Planned academically-based enforcement
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Faculty Handbook
The university expects that students will be honest
with their professors about routine illnesses, injuries,
and mental health problems that may lead to missed
classes, labs, studios, exams, or deadlines.
Academic advising staff and associate deans are
available to provide assistance to students or faculty
members who have concerns about attendance
issues. See also the CU Health Excuse Policy
www.gannett.cornell.edu/services/health-excuses.cfm
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Serious, ongoing illness or
injury
When a student is hospitalized or has a serious
illness or injury ― and with the student's consent ―
Gannett will contact Cornell's Crisis Manager to
coordinate communication with the student's
college. To facilitate an academic accommodation,
and at the student's request and with the student's
permission, Gannett will communicate further with
the college's academic advising office and/or
Student Disability Services.
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Recommendations
• Engage clinicians on common approach
• Identify academic partner(s)
– Review practical and philosophical concerns
– Build off honor code if present, or institute as
free-standing policy if not
– Aim for co-ownership
• Get students involved
• Communicate a simple policy through
academic channels
• Plan ahead for enforcement
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Other recommendations,
approaches, and steps
• Have your institutions had success with
similar or different approaches?
• Would it be helpful to have an ACHA position
paper on this topic?
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Web Links
• Cornell
http://www.gannett.cornell.edu
• Duke
http://www.studentaffairs.duke.edu/stud
enthealth
• Princeton
http://www.princeton.edu/uhs
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