Lecture for year 3
medical students on December 16, 2014 at the Faculty of Medicine King Fahad
Medical City, Riyadh, Saudi Arabia by Professor Omar Hasan Kasule Sr 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 career’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 recognise 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 recognise 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.
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)
