Online psychiatrist and medical sick leave (L4) – answers to the 7 most common questions
There is a moment when a very specific question appears in your head:
“I can’t cope. Can an online psychiatrist issue me L4?”
You don’t then look for general theory about wellbeing. You want clear information:
is it even legal,
how long can the sick leave last,
what will the employer see,
do you need to “have depression” to get it.
In this post I collect in one place the 7 most common questions about L4 from an online psychiatrist – so you can calmly understand the rules before you click “book an appointment”.
There are no promises of “L4 in 15 minutes” here.
There is an honest answer: when sick leave is part of treatment and when the doctor may say “not this way yet”.
1. Can a psychiatrist issue L4 during an online visit?
Yes – an online psychiatrist can issue L4, i.e., an electronic medical sick leave certificate (e‑ZLA).
Two conditions apply:
the doctor has the authority to issue sick leave,
based on the interview they determine that your mental health condition actually prevents work.
Keep this sentence in mind:
During an online consultation a psychiatrist can issue L4 if, based on the interview, they determine that your mental state truly prevents work. There is no automatic “L4 on the spot” – sick leave is part of treatment, not a service ordered on demand.
So: you are not buying L4.
The doctor makes a medical decision – just as in a face-to-face clinic.
2. How long can L4 from an online psychiatrist last?
There is no single magic number of days.
In practice:
L4 from a psychiatrist (including online) may last from a few days to several weeks, sometimes longer if the condition is severe,
the total time on sick leave due to illness (not only psychiatric) is limited by regulations (commonly 182 days of sickness allowance),
the doctor usually issues the first L4 for a shorter period (e.g., 2–4 weeks) and decides at follow-up visits whether to extend it.
It is not the case that on the first visit you get “a 6-month package”.
Sick leave is tailored to:
symptom severity,
type of work (safety, responsibility),
how you respond to treatment.
3. Does the employer see that the sick leave was issued by a psychiatrist?
This is one of the most frequently asked questions – and I understand it, because fear of stigma can be huge.
The good news:
the employer does not see the diagnosis or that L4 was issued by a psychiatrist,
they only see that:
– you have medical sick leave,
– from when to when,
– for what reason (e.g., your own illness), but without the disorder name.
So: the system knows that you are unfit for work, but doesn’t say whether it’s depression, anxiety disorders, burnout, or anything else.
You have full right to decide what and to whom you say anything.
You can say generally: “I am on medical leave for health reasons” – and that is 100% sufficient.
4. Does a psychiatrist online issue L4 on the first visit?
They can – but this isn’t the rule.
On the first psychiatric consultation the doctor:
takes a full history (how long symptoms have lasted, how they affect work and life),
assesses whether we are dealing with a crisis, burnout, adjustment disorder, depression, anxiety, etc.,
checks whether you have previously tried anything (therapy, vacation, changing duties).
If from this picture it follows that:
your functioning at work is actually impaired,
continuing work at this time worsens the problem,
you need time for treatment and recovery –
then L4 can be issued already at the first visit.
If symptoms are milder or shorter, and you still “function” despite difficulties – the doctor may propose other steps (treatment, therapy, follow-up) without L4 at the start.
Important: you don’t have to be afraid to ask.
You can say directly:
“I’m wondering whether L4 is necessary in my situation. I would like you to assess that.”
5. Can I ask for L4 if I’m “just not coping”?
You can say that you’re not coping – and that is very important information for the doctor.
But medically what matters is what’s behind that “not coping”:
Is it a temporary crisis after one project?
Have you had months of symptoms of depression or anxiety?
Does your condition prevent normal functioning – not only at work but also outside it?
If “not coping” means:
chronic fatigue, lack of sleep, constant anxiety, crying,
difficulty performing basic duties,
errors that become dangerous –
then we’re talking about something more than simply “having a hard time”.
And yes, in such a situation L4 can be part of treatment.
But not because you asked for it, but because there are real indications for it.
6. Is L4 from an online psychiatrist different from a “regular” L4?
Formally – no.
It is the same e‑ZLA, visible to ZUS and the employer.
The rules for remuneration and sickness allowance are the same as with L4 from a general practitioner or another physician.
Sick leave from an online psychiatrist counts the same toward the 182-day limit as any other.
The difference is only in who issues it and in what context:
psychiatrist – in relation to mental disorders (depression, anxiety, adjustment disorders, burnout with symptoms),
primary care physician – more often in the context of somatic illnesses, although they may also issue L4 during a mental health crisis.
7. What can I do to make the “psychiatrist online L4” visit really about me, not just about “the paperwork”?
The most important thing: don’t position yourself as a petitioner requesting L4. You come as a person who is suffering and seeking help – that makes a huge difference.
Before the visit you can:
write down your symptoms (what, since when, how often),
write 2–3 sentences about how work affects your mental health,
note for yourself what you are afraid of (losing your job, team reaction, finances).
And during the visit say directly:
“I can’t cope. I see signs of burnout / depression in myself. I’m wondering whether L4 would make sense in my case – please give an honest assessment.”
And let the doctor do what they do:
name what is happening,
propose treatment,
say: “yes, in this situation I will issue L4” or “let’s try something else first”.
If you feel you’ve been running “on empty” for a long time, wake up with stomach pain thinking about work, and your head refuses to cooperate – you don’t have to wait until it’s “really bad”.
You may consider a consultation with an online psychiatrist:
so someone from outside can see the whole picture of your situation,
help distinguish a “tired person” from someone experiencing depression or severe burnout,
and decide with you whether L4 is necessary in your case or whether another form of support is sufficient at this stage.
This text is for informational purposes. It does not replace individual medical consultation or psychotherapy. Decisions about treatment and sick leave should always be made together with a specialist, looking at the specific person, not just a list of symptoms from the internet.
