Adrian Massey, an occupational physician, has written a polemic against Britain's policy of medical certification of employee sickness by doctors. His self-proclaimed objective “is to convince the reader that the principal medical intervention used to manage sickness—the requirement for doctors to certify it—is folly” (ix). He argues that much illness is not verifiable by doctors, who are nonetheless burdened with deciding whether someone's subjective experience of symptoms requires leave from work. To Massey, the result is a warping of the role of medical practitioner, focused more on acceding to a patient's self-diagnosis for fear of complaints than spending time to offer an honest opinion, while the primary care system also suffers as needless consultations reduce the time general practitioners can spend on truly helping their patients. British society would be better served, he contends, by emphasizing the need for more enlightened and honest management in the workplace. Direct assessment of worker skills and abilities by employers, improvement of the work environment, assistance for employees returning to work after sickness, and a forthright approach to “truculent absentees” (271) would all be more productive than a third party (that is, the doctor) trying to verify whether someone was fit to work. Ultimately, Massey questions the utility of the sickness benefit itself: could the millions spent on assessment and administration not be “redistributed to sick people through an enhanced system of disability benefits instead” (281)?

Massey writes clearly and passionately, and his frustrations with the role of doctors in the administration of the sickness benefit merit reading by anyone interested in health and social policy in modern Britain. He offers evidence of the opinions of the medical profession more broadly on such matters, illustrating that he is not a “lone wolf” in his dissatisfaction and that such grievances are long held among his peers. Indeed, the sharp sarcasm peppered throughout the book seems directed more at an audience whose sympathy is known rather than an audience whose support is sought. His observation that patient complaints about their doctors rose after the conviction of Dr. Harold Shipman for the murder of fifteen patients in 2000 is interesting; his identification of this trend as a newly “received wisdom that all doctors must be treated as sociopaths in waiting” feels jarringly wry (97).

Academic readers will likely be disappointed by the attempts to explain why the “sick-note” became so central in British social policy. To be fair, Massey is not a professional historian, and he makes no claim to ground his analysis in either secondary scholarship or archival research. The result is a broadly sweeping account of the effect of industrialization on community, work, and care for the sick. Preindustrial Britain is cast in a nostalgic glow: a harmonious society in which personal relationships and the obvious signs of disease allowed the “politics of sickness” to be addressed with clarity, generosity, and consensus (11). The enlarged and fragmented communities of industrial society spawned bureaucracy and suspicion, with the doctor emerging as the expert who could supposedly assure that assistance was given fairly and justifiably. Drawing on the work of philosopher Ivan Illich, Massey also argues that the medicalization of human frailties and social problems compounded sick-note culture. Issues that would have once been discussed with a priest (such as grief) or a trade union representative (such as poor working conditions) became medical sicknesses (such as depression and stress) to be diagnosed by the doctor.

What is difficult to tell by the end of the book is the extent to which Massey sees sick-note culture as a peculiarly British problem. His analysis points to issues that extend beyond Britain (see the trenchant criticism of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders in chapter 10), but there is no indication whether he believes that other countries have developed policies that address common problems better, or perhaps even worse. His primary concern, of course, is to highlight the weaknesses of Britain's own approach, but a nod toward other countries would have been helpful and clarifying.