Doctor’s Note Policies Punish Students For Being Poor

It’s said that during the holidays, all roads lead home ― or, for those who have access, to the doctor.

The holiday season is like being invited to a white elephant gift exchange only to find out that each beautifully wrapped box contains a different variation of stomach virus, cold, strep or the flu. Sick students need to stay stay home and miss school. And doctor’s notes verifying a student is sick and unable to attend class have become as elusive and rare as one of Willy Wonka’s infamous golden tickets for millions of children in America.

In a country like the U.S. (in which adequate health care is far from an easily accessible human right), it’s ridiculous that students are still required to provide a note from a medical practitioner to receive an excused absence. Such policies disproportionality affect economically disadvantaged youth and youth of color and serve as yet another reminder that our educational and medical systems are designed to set certain students up for failure.

Economically disadvantaged youth and youth of color are often synonymous in America ― 1 in 3 black, Native American and Hispanic children live in poverty, compared to 1 in 10 white children. Children who live in poverty are more likely to go uninsured than children who don’t, and the total number of uninsured young people in America is on the rise.

For the 3.9 million children living without health care coverage, the very ability to go to the doctor when they’re sick and to get “permission” to miss school is little more than a dream. And while many uninsured children qualify for some type of government coverage, their ability to obtain that coverage is often out of their hands. Parents who lack coverage for themselves (for any variety of reasons) are often unfamiliar with the inner workings of America’s health care system and therefore don’t know how to seek government assistance for their kids.

Medicaid is often depicted as the be-all, end-all answer for those who can’t afford health care, but Medicaid coverage often perpetuates a cycle that keeps families who strive to rise above the poverty line in fear of losing affordable health care if they do.

I was raised by a single mother who worked multiple jobs, and as a young child, I received Medicaid coverage. As my family transitioned into different income brackets, I lost that coverage and went without health insurance entirely when my mother made enough money to keep food on the table and gas in the car but made too much to qualify for government assistance. Once we could afford our own private health insurance coverage, we were still often unable to afford the copays and out-of-pocket expenses necessary to utilize the medical system. Our story is just one of many like it.

Even students who do have adequate health care coverage (and can therefore obtain one of those elusive doctor’s notes to excuse their school absences) are ultimately reliant on other factors outside of their control when they need to see a physician. Many times, a simple cold, stomachache or other illness can be cured with home remedy and rest. The necessity of a doctor’s note, even for children with insurance, can place undue financial stress on parents whose work situation doesn’t give them the flexibility to accompany their kid to the doctor.

If a parent’s schedule does allow for a trip to the physician, the high cost of copays, deductibles and prescriptions mean many Americans must scrape together what should’ve been that week’s grocery, gas or electric bill money just to provide their child’s school with a slip of paper. And this doesn’t even take into account the inherent assumption that all parents have access to private or public transportation, a luxury many often take for granted. For 45 percent of the American population, public transit is nonexistent where they live.

I know from experience that for families in situations like these ― who lack adequate health care or who are barely able to afford the coverage they do have ― a certain set of criteria must be met before going to see the doctor for one of those notes. How bad does it hurt? Is it broken? Is your temperature “too high”? Depending on the answers, we either stayed home or went to school anyway.

This is the kind of criteria we’ve forced upon economically disadvantaged youth. Kids learn at a young age that health care, and the ability to take full advantage of what the system has to offer, is a rich man’s game.  

You might be wondering: Does it really matter if a child has unexcused absences? What’s the big deal? Schools often create their own policies as to what qualifies as an excused or unexcused absence. If an administration decides a missed class for health reasons without a note from a physician is “unexcused,” it can impact students’ grades; many teachers take these absences into consideration when calculating a student’s overall letter grade. And in many districts across America, if a student has unexcused absences, they lose the ability to participate in extracurricular activities and sports as punishment.

In more extreme cases, students with multiple unexcused absences over an extended period of time are considered truant. This can leave parents facing hundreds of dollars’ worth of truancy fines and even time behind bars. Penalties like these have a far greater negative impact on youth who already come from economically disadvantaged families.

We have a misconception here in America that children have access to health care via their school nurse, and that the nurse can excuse a child’s absence based on their own diagnosis. While this does happen, not all students have access to this kind of care; only about 82 percent of public elementary and secondary schools have full- or part-time nurses on staff (the number is even lower for private institutions). Students who can’t get a doctor’s note and who don’t have access to a school nurse find themselves in a lose-lose situation when it comes to their attendance record.

Doctor’s note policies have no place in our K-12 schools. We shouldn’t punish America’s children for being denied their basic human right to health care (or for having parents without the financial means to take advantage of the health care they do possess).

What we need are policies that are empathetic toward our country’s economically disadvantaged youth. If a parent says their child’s absence is health-related, that absence should be considered excused ― case closed. And because these policies are determined by local educational agencies, changes will only come via discussion at a local level ― school boards, parent-teacher associations, town hall meetings and other public forums.   

Economically disadvantaged youth and youth of color are already perpetually discriminated against in America’s schools. The least our educational system can do is remove one stressor from the equation.

Until then, doctor’s notes will continue to provide opportunity and access only to those who can afford it.

Jana-Elisse Clevenger is a former intelligence analyst with the U.S. Army. She’s now currently a full-time student at Vassar College as a recipient of the Posse Foundation’s Full-Tuition Leadership Scholarship.