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Lecture
for year 3 medical students on December 16, 2013 at the Faculty of Medicine
King Fahad Medical City, Riyadh, Saudi Arabia by Professor Omar Hasan KasuleSr
MB ChB(MUK), MPH (Harvard), DrPH (Harvard)
LEARNING
OBJECTIVES
·
To familiarize students with the
role of the doctor in certifying an illness or disability
·
To explore clinical, social and
ethical issues associated with the doctor's responsibility to certify disease
or disability in individuals.
KEYWORDS
Certification
of disease or disability
AGENDA/CONTENT
·
Reasons for seeking a medical
certificate
·
Different forms of certification
·
Documentation issues for
certificates related to clinical problems
·
Social/societal/ethical issues
associated with issuing medical certificates
·
Legal issues associated with
issuing medical certificates
SCENARIOS
Scenario
#1:
·
A senior consultant approached
you and asked for a medical certification for a 2-day sick leave. He asks to
write that he is sick with a serious anxiety disease but the truth is that he
wants to take his wife to another town for treatment a mental breakdown due to
discovery that she contracted a sexually transmitted disease in her recent
travel.
·
What issues are involved in this
scenario?
·
How would you deal with this
situation?
Scenario
#2:
·
A relative asks you to change the
death certificate to say that his daughter died from complications of
appendicitis because the true cause of the death, an infected induced abortion,
would be shameful to the family.
·
What issues are involved in this
scenario?
·
How would you deal with this
situation?
Scenario
#3:
·
You are employed full by the
factory as a doctor to treat the worlers and you report to the General Manager
·
A worker comes to see you about
his alcohol and drug problem. You treat him and you promise not to reveal his
secret to the Manager because he will lose his job
·
The Manager suspecting that the
worker had an alcohol and drug problem asks you to give him a report about the
patient.
·
What do you do?
Scenario #4:
·
A worker falls during work and
breaks his collar bone. As a company doctor you treat him until he recovers
·
The worker sues the company
seeking damages for the work-related injury
·
The General Manager asks you not
to release any records to the court because the company will have to pay a big
amount of money that will lead to bankruptcy
·
What do you do?
REASONS
FOR SEEKING A MEDICAL CERTIFICATE / FORMS OF CERTIFICATION
·
A certificate certifying illness may be issued where a patient's
state of health necessitates time away from the work-place, school, or other
relevant activities.
·
Another certificate may be required for carer’s leave
entitlement.
·
Death
·
Disability and compensation
EXAMPLES
OF CERTIFICATES /
·
Certificate of illness for sick
leave
·
Certificate of medical fitness
·
US Veteran certificate of
disability
·
Certificate of disability
·
US Death Certificate
MAIN
ELEMENTS OF A CERTIFICATE
·
Name and address of the medical
practitioner issuing the certificate
·
Name of the patient;
·
Date on which the examination
took place;
·
Date on which the certificate was
issued;
·
Date(s) on which the patient is
or was unfit for attendance;
·
Supplementary information
·
A diagnosis if required and if no
confidentiality issue arises
·
The certificate should be legible
and written so that a non-medical person is able to read and understand it.
·
The certificate should be written
on stationery designed specifically for this purpose.
·
Medical practitioners have a
responsibility to obtain and note sufficient factual information through
history and examination to issue a sickness certificate.
Source: Australian
Medical Association www.ama.au/position-statement/guidelines-medical-practitioners-certificates-certifying-illness-2011
RESPONSIBILITIES
OF THE MEDICAL PRACTITIONER …1
·
Medical certificates are legal
documents. Medical Practitioners who deliberately issue a false, misleading or
inaccurate certificate could face disciplinary action under the Law.
·
Employers may, in reasonable
circumstances, seek further information from the medical practitioner who
issued a certificate. Before providing any further information to the employer,
the medical practitioner should verify the employer’s identity and obtain
express consent from the patient before disclosure of the further relevant information
to their employer.
Source: Australian
Medical Association www.ama.au/position-statement/guidelines-medical-practitioners-certificates-certifying-illness-2011
RESPONSIBILITIES
OF THE MEDICAL PRACTITIONER …2
·
Where an employer contacts the
medical practitioner to verify the veracity of a sickness certificate (eg., to
determine if it’s fraudulent in any way), the medical practitioner should
verify the employer’s identity and confirm the veracity of the certificate. The
doctor should not provide any other information about the patient without the
patient’s express consent.
·
The doctor may decline to provide
a certificate if he or she feels it is inappropriate to do so.
Source: Australian
Medical Association www.ama.au/position-statement/guidelines-medical-practitioners-certificates-certifying-illness-2011
THE RESPONSIBILITIES OF PATIENTS
·
Patients have a responsibility to
consult their medical practitioner in a timely manner when requesting a sickness
certificate.
·
Patients also have a
responsibility to present the reasons for requesting a certificate in a way
that enables the doctor to make an accurate assessment of their eligibility for
a certificate.
·
At the time the certificate is
issued, it is the responsibility of the patient to ensure that the employer's
requirements for leave have been met.
·
Patients must not alter the
certificate in any way.
Source: Australian
Medical Association www.ama.au/position-statement/guidelines-medical-practitioners-certificates-certifying-illness-2011
THE RESPONSIBILITIES OF EMPLOYERS
·
Employers should recognize the
right of their employees to keep details of their medical condition
confidential. Employers should not expect to see a diagnosis on the
certificate. Employers should also recognize that the certification by the
medical practitioner of an employee's unfitness for work is sufficient.
·
The employer has a responsibility
to inform the employee of the requirements for sick leave.
Source: Australian
Medical Association www.ama.au/position-statement/guidelines-medical-practitioners-certificates-certifying-illness-2011
DATE OF CERTIFICATE …1
·
Certificates must be dated on the
day on which they were written. Under no circumstances can this be breached.
·
There may be medical conditions
which enable the medical practitioner to certify that a period of illness
occurred prior to the date of examination. Medical practitioners need to give
careful consideration to the circumstances before issuing a certificate
certifying a period of illness prior to the date of examination, particularly
in relation to patients with a minor short illness which is not demonstrable on
the day of examination and add supplementary remarks, where appropriate, to
explain any discrepancy.
·
Source: Australian Medical Association www.ama.au/position-statement/guidelines-medical-practitioners-certificates-certifying-illness-2011
DATE OF CERTIFICATE …2
·
Medical practitioners should be
clear that their assessment of the patient is based on the patient’s history
and the findings of the examination. The certificate may include information
provided by the patient but the medical practitioner’s assessment should be
based on illness or injury observed by the medical practitioner or reported by
the patient and deemed to be true by the medical practitioner.
·
Medical practitioners should
retain a copy of a patient’s sickness certificate.
·
Source: Australian Medical Association www.ama.au/position-statement/guidelines-medical-practitioners-certificates-certifying-illness-2011
WHEN A SICKNESS CERTIFICATE SHOULD NOT BE PROVIDED
·
A certificate should not be
provided where a doctor believes that there is insufficient evidence of disability.
·
Wherever possible, doctors should
avoid issuing sickness certificates to anyone with whom they have a close
personal relationship.
·
Source: Australian Medical Association www.ama.au/position-statement/guidelines-medical-practitioners-certificates-certifying-illness-2011
CERTIFICATES FOR CARERS’ LEAVE
·
Only the patient’s treating
doctor should issue a carer’s certificate. Carer’s certificates should only be
issued with the consent of the patient.
·
It is not the treating doctor’s
responsibility to determine who may qualify as a carer.
·
Source: Australian Medical Association www.ama.au/position-statement/guidelines-medical-practitioners-certificates-certifying-illness-2011
DEATH
CERTIFICATE
·
The failure of a physician to
immediately certify death may be a crime and a professional misconduct
·
A paramedic may sign a death
certificate if the cause of death is obvious and there is no suspicion of
criminal intent such as old age and accidents with no chance of survival (eg
decapitation)
ACCURACY OF THE CAUSE OF DEATH
·
Major errors 38.3%, minor errors
77.6%, mechanism of death listed as cause of death 21.9% (Indian J Public Health. 2009
Jan-Mar;53(1):31-3)
·
underlying cause of death was misdiagnosed in 80.3% of the death reports (J Family Community
Med.
2008 Jan;15(1):43-50)