# Doctors are a lot to blame giving sick certs.



## ajapale (22 Nov 2011)

cork said:


> Doctors are a lot to blame giving sick certs.



A GP's primary role is to treat sick people: its not to act as an industrial relations arbitrator in my opinion.


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## Purple (22 Nov 2011)

Some doctors give out certs without seeing the "sick" person. This is most common with long-term sick leave. I find this most suspect.


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## Firefly (22 Nov 2011)

ajapale said:


> A GP's primary role is to treat sick people: its not to act as an industrial relations arbitrator in my opinion.



On the face of it I agree and a GP certainly shouldn't be promoting the issuing of a sick cert. But if a patient requests one then a GP would be open to a liable action if they refused to issue one...


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## Purple (22 Nov 2011)

Firefly said:


> But if a patient requests one then a GP would be open to a liable action if they refused to issue one...



Not sure about that.


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## blueband (22 Nov 2011)

Firefly said:


> On the face of it I agree and a GP certainly shouldn't be promoting the issuing of a sick cert. But if a patient requests one then a GP would be open to a liable action if they refused to issue one...


 very true, or how would the doctor who refused to issue a cert feel if the person when to work and had an accident through illness, or fell down dead!


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## T McGibney (22 Nov 2011)

Firefly said:


> But if a patient requests one then a GP would be open to a liable action if they refused to issue one...


With respect, this is nonsense. As an accountant, over the years I have turned down many requests to certify stated 'earnings' that were unsupported by evidence. There is no question whatsoever that any such refusal could be deemed as libel.


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## Purple (22 Nov 2011)

blueband said:


> very true, or how would the doctor who refused to issue a cert feel if the person when to work and had an accident through illness, or fell down dead!


Using that logic everyone who ever presents at a GP's surgery should get a cert. The GP should use their judgement and make a diagnosis based on medical requirement, not based on what they think they need to do to keep their customer/ make an easy €50.


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## T McGibney (22 Nov 2011)

blueband said:


> very true, or how would the doctor who refused to issue a cert feel if the person when to work and had an accident through illness, or fell down dead!



A professional's cert is worthless if they are susceptible to moral blackmail.


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## blueband (22 Nov 2011)

T McGibney said:


> With respect, this is nonsense. As an accountant, over the years I have turned down many requests to certify stated 'earnings' that were unsupported by evidence. There is no question whatsoever that any such refusal could be deemed as libel.


 with respect, you can hardly compare the two professions!


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## T McGibney (22 Nov 2011)

.............


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## T McGibney (22 Nov 2011)

blueband said:


> with respect, you can hardly compare the two professions!



Sorry I don't understand what you are getting at?


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## Sunny (22 Nov 2011)

T McGibney said:


> Sorry I don't understand what you are getting at?


 
Well you can ask for evidence to back up claims as an accountant. If I go to a Doctor with a serious Migraine, what is he going to ask me for apart from a list of symptoms. Is it then up to the Doctor to call me a liar?

Or back trouble? Not everyone looking for a cert is lying about their problems.


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## Firefly (22 Nov 2011)

T McGibney said:


> With respect, this is nonsense. As an accountant, over the years I have turned down many requests to certify stated 'earnings' that were unsupported by evidence. There is no question whatsoever that any such refusal could be deemed as libel.



As an accountant you would be liable if you certified accounts that were incorrect. As a doctor you would be liable if you refused to certify a patient who claimed they are sick and then went on to injure themselves at work.

The two professions are miles apart. An account will seek physical proof of income/expenses etc by looking at bank statements (plus a lot more I imagine). On the other hand a GP has to go largely on what they are being told by the patient. For example, if I present myself with intermittent back pain to my GP and tell him I get pains every 2 hours or so for 15 minutes, how is he to argue with me? He can and should arrange an MRI scan or similiar but he would be very foolish to deny me a sick cert if I asked him.

In any case, the patient looking for a dodgy sick cert is the key person to blame here.


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## T McGibney (22 Nov 2011)

Firefly said:


> As a doctor you would be liable if you refused to certify a patient who claimed they are sick and then went on to injure themselves at work..



No you wouldn't. End of.


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## Latrade (22 Nov 2011)

Sunny said:


> Well you can ask for evidence to back up claims as an accountant. If I go to a Doctor with a serious Migraine, what is he going to ask me for apart from a list of symptoms. Is it then up to the Doctor to call me a liar?
> 
> Or back trouble? Not everyone looking for a cert is lying about their problems.


 
I'd agree, the GP can only make a call on the symptoms described by the patient. In an ideal world the would be able to run detailed diagnostics and MRIs there and then, but that isn't possible. If it is a long term sickness, then the employer has the right to seek a second opinion as to the extent of the illness and to measure fitness for work through their own occupational physician.

I do sympathise with GPs that they aren't occupational specialists in many cases and so have to make a professional judgement based on the symptoms described and based on the work as described by the employee.

That doesn't mean the system isn't in need of some fixing. For example, rather than a blanket medical certificate, one (as in the UK?) that states the exact nature of the work the employee is unable to conduct, so employee can still present for work, but work in a limited capacity.


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## T McGibney (22 Nov 2011)

Sunny said:


> Well you can ask for evidence to back up claims as an accountant. If I go to a Doctor with a serious Migraine, what is he going to ask me for apart from a list of symptoms. Is it then up to the Doctor to call me a liar?
> 
> Or back trouble? Not everyone looking for a cert is lying about their problems.



Except that declining to issue a cert is not tantamount to calling anyone a liar.


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## Sunny (22 Nov 2011)

T McGibney said:


> No you wouldn't. End of.


 
You might not be liable from a legal point of view but they are open to professional mis-conduct cases if they just ignore a Patients complaints and refuse to issue a cert and something then happens the patient in work.


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## T McGibney (22 Nov 2011)

Sunny said:


> You might not liable from a legal point of view but they are open to professional mis-conduct cases if they just ignore a Patients complaints and refuse to issue a cert.



Not if they are doing their job properly. The doctor is entitled to their professional opinion, based on proper execution of their own duties in forming that opinion, even if the opinion is later shown to be incorrect.


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## Sunny (22 Nov 2011)

T McGibney said:


> Except that declining to issue a cert is not tantamount to calling anyone a liar.


 
It pretty much is unless you are absolutely sure that someone is fit for work and is not suffering like they say. As another poster said, maybe more specific certs are the answer rather than general certs and employers can always insist on other medical opinions if they wish.


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## T McGibney (22 Nov 2011)

Sunny said:


> It pretty much is unless you are absolutely sure that someone is fit for work and is not suffering like they say.



We're going round in circles here but does no doctor *ever* say 'I can't find anything wrong with you'? That's not calling anyone a liar.


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## Sunny (22 Nov 2011)

T McGibney said:


> Not if they are doing their job properly. The doctor is entitled to their professional opinion, based on proper execution of their own duties in forming that opinion, even if the opinion is later shown to be incorrect.


 
No offence, but that is simply untrue. There are numerous cases of doctors being struck off for mis-diagnosis or ignoring patients complaints.


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## T McGibney (22 Nov 2011)

Sunny said:


> No offence, but that is simply untrue. There are numerous cases of doctors being struck off for mis-diagnosis or ignoring patients complaints.



You will find in those cases that the professional malpractice is in the procedure, ie ignoring or failing to investigate the complaint properly, rather than the opinion that is reached.


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## Sunny (22 Nov 2011)

T McGibney said:


> We're going round in circles here but does no doctor *ever* say 'I can't find anything wrong with you'? That's not calling anyone a liar.


 
You are the one going around in circles. There are some illnesses that can't be diagnosed by a simple check up in a GP's surgery. It doesn't mean there is nothing wrong with someone and the doctor is perfectly entitled to issue a cert even if he can't verify the patients complaints. 

The problem is with people abusing the systems. Not doctors who face an impossible job. Let employers deal with it if they think an employee is lying.


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## Sunny (22 Nov 2011)

T McGibney said:


> You will find in those cases that the professional malpractice is in the procedure, ie ignoring or failing to investigate the complaint properly, rather than the opinion that is reached.


 
You talk about circles. Giving up now.


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## T McGibney (22 Nov 2011)

That hardly applies to the normal case of someone who presents with a cold, is told to take a few lemsips or perhaps some paracetemol, and then asks for a cert "cos I don't feel like going to work today".


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## Sunny (22 Nov 2011)

T McGibney said:


> That hardly applies to the normal case of someone who presents with a cold, is told to take a few lemsips or perhaps some paracetemol, and then asks for a cert "cos I don't feel like going to work today".


 
And you have evidence that doctors are issuing certs to people who present themselves saying they have a common colds on a widespread basis do you? I would love to see it. Like all the accountants who covered themselves in glory over the past few years but lets not comdemn an entire profession.


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## Firefly (22 Nov 2011)

I'm sick of this thread...can anyone give me a cert?


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## oldnick (22 Nov 2011)

The GANFYD syndrome is well documented (get a note from your doctor).

Going back to 2003 a report in British Medical Journal Dec 2003  as well as a study by univ of Aberdeen ,reported 23.12/03 ( google it BBC) states that ....

Whilst they believe that most patients may be feeling unwell, even when the doctors doubted the patients claim the doctors did not feel it worth jeapordising the doctor-patient relationship over a small matter like wiritng a sick note (now called fit notes in UK).

So, yes, doctors do write notes willy-nilly but mainly because they're under work pressure ,under patient relationship pressure -and because they don't really think it's that bad a thing to do -( i.e. let the state/employer pay -so what).

British GPs are very happy that they will no longer be asked to write sick(fit)notes for longer-than-a-month illnesses. There has been so much absue of this that from now on a long-term sick patient must be independently assessed by a panel.


(As a side-note when it comes to legal-insurance claims , of which I'm very familiar from the travel business , doctors are very reluctant to sign something that can be used in court, unless there is ample proof that the patient did really have a certain condition).

P.S. -and don't doctors get paid for every visit/note they write?


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## Latrade (22 Nov 2011)

T McGibney said:


> That hardly applies to the normal case of someone who presents with a cold, is told to take a few lemsips or perhaps some paracetemol, and then asks for a cert "cos I don't feel like going to work today".


 
Can't believe I'm sticking up for doctors against employers, but...

There are key issues to separate out in this debate. There is the long term sick and medical certificates for that and short term.

But we also have to consider employment policies. So for example, some employers allow for a number of days "self-certified" (as in not requiring a medical note). However, some employers insist on medical certificates for even 1 day's absenteeism, therefore people do have to go to the doctors to get a certificate for "having a dose".

Also consider the medical professional view is it really for them to promote people going into work to spread viruses and colds?

This isn't to say GPs are perfect, but they're not solely to blame. Yes I have come across some GPs who appear quick to issue a certificate for a week and others who are more thorough, but again in my experience we're talking about a minority over a majority.

In addition, I have come across a GPs stating quite explicitly that the patient has presented the symptoms or in some cases with the caveat "according to the patient". I've come across more than a few that have even stated that they "can find no physical evidence for the symptoms discussed" and they recommend a more detailed diagnosis that is outside of their remit.

In theory it may be easy for me to describe back pain to my GP, state I work in a job that requires lifting and carrying, cry in pain with the rudimentary tests that are available to my GP in their practice and be told it appears I'm not fit for work for a month or more. 

However, it's then up to my employer as to whether they accept that certificate at face value or decide they would like a second opinion/more analysis of the full nature and extent of this limited diagnosis. 

Medical Certs come with the caveat of an initial opinion from the view of the symptoms described, employers are free to have that confirmed.


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## Purple (22 Nov 2011)

GP's shoudln't be allowed to certify long term illness certs. It should only be done by occupational health specialists who are then audited by the HSA.


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## Mpsox (22 Nov 2011)

As an employer, sometime I have issues with sick notes presented to me. On a number of occassions, I've refused to accept a sick note for people who were off sick for one day and the note said "flu". (Not flu like symptoms, just flu). You don't get the flu for a day. Likewise, I've refused to accept certs which state someone is "sick", without outlining what is wrong with them. 

I do find the different attitudes to sickness interesting. I've only ever had food poisoning once in my life but some people seem to get it every 6 months. Maybe it's poor hygiene or they just keep going back to the same restaurant, even though it makes them sick. 

Personnally, as someone who grew up on a farm, I got little sympathy if I was sick, cows don't milk themselves. Strangely in 20 years working in an office I've had 3 days sickness (and I'm excluding accident related issues here), some people manage that in 20 weeks


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## RonanC (22 Nov 2011)

Mpsox said:


> Likewise, I've refused to accept certs which state someone is "sick", without outlining what is wrong with them.


 
As an employer, you have no legal right to demand a reason for a staff member being sick. You are only entitled to know if the staff member is fit to work or not.



Mpsox said:


> I've only ever had food poisoning once in my life but some people seem to get it every 6 months..


 
Lucky you! Food poisoning is a very serious issue and can result in death! I've had it on several occasions and I would consider myself a "fairly" healthy person and always watch what I eat. I wont even begin to tell you how I felt the last time I had it which was earlier this year. 



Mpsox said:


> Strangely in 20 years working in an office I've had 3 days sickness (and I'm excluding accident related issues here), some people manage that in 20 weeks ..


 
Again, I have to say lucky you. I would love to be able to get rid of the migraines I suffer with, that can leave me rolling around in pain for days on end. My doctor cannot help me apart from prescribing me seriously expensive tablets, that are not even guaranteed to work. I wish I could also get back all those sick days I have taken, and the annual leave days taken instead of sick days because I hate taking sick days, and also the money paid to doctors for medical certificates over the years. It drives me mad when people say, oh well I have never been sick in my life, so how can you take so many days off?


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## truthseeker (22 Nov 2011)

Mpsox said:


> only ever had food poisoning once in my life but some people seem to get it every 6 months. Maybe it's poor hygiene or they just keep going back to the same restaurant, even though it makes them sick.


 
Some people have less strong immune systems than others.


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## ajapale (22 Nov 2011)

Purple said:


> GP's shoudln't be allowed to certify long term illness certs. It should only be done by occupational health specialists who are then audited by the HSA.



Thats a marvellous suggestion in my opinion. It takes the decision away from the doctor-patient relationship and hands it to a trained professional specialist who is trained to make this kind of judgement.


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## micmclo (22 Nov 2011)

Mpsox said:


> Likewise, I've refused to accept certs which state someone is "sick", without outlining what is wrong with them.



It's not for you to do that.
You are an employer, not an medical professional and you can't judge if it's genuine or not.
All you need to know is if they fit and able to work, not the reasons behind it

What if your employee needed time off for stress. If they admit to you they are stressed they know you won't promote them if they are struggling.
Or if it was the first stages of a serious illness and in the future more time off would be needed they would fear you'd get rid of them at the next opportunity. Maybe not fire them but slash their hours so they have to leave

If you want to know more you need to send them to a company doctor and the company will pay the bill


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## terrysgirl33 (23 Nov 2011)

Purple said:


> Some doctors give out certs without seeing the "sick" person. This is most common with long-term sick leave. I find this most suspect.



FWIW, I have been out for up to 6 weeks with depression.  I hated doing it, particularly as I was up and about a doing stuff, but I just couldn't pull myself together to go to work (work is not a problem in it'self, the problem was me).  I was prescribed anti-depressants, but they take at least 3 weeks to build up in your system, and usually longer until you feel able for ordinary stuff.  I needed a cert every week for social welfare (illness benefit) but I didn't need to see a doctor for at least 3 weeks from my initial visit, so I got a cert every week without seeing a doctor.  I rarely take sick leave, but I had to on this occasion.


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## Purple (23 Nov 2011)

That’s fine as long as the doctor can stand over the rational for not seeing you and doesn’t charge a full consultation fee for issuing it (I don’t see how anyone could charge more than €10 for this sort of standard letter).


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## terrysgirl33 (23 Nov 2011)

Purple said:


> That’s fine as long as the doctor can stand over the rational for not seeing you and doesn’t charge a full consultation fee for issuing it (I don’t see how anyone could charge more than €10 for this sort of standard letter).



It's not a standard letter, it's a form that has to be filled in for social welfare.  It seems to vary a lot as regards charges for this, my doctor didn't charge me, but I've heard of others who get charged for a full consultation!!

I thought medical card patients were covered by a flat fee to the doctor, not a charge per visit?


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## Purple (23 Nov 2011)

terrysgirl33 said:


> It's not a standard letter, it's a form that has to be filled in for social welfare.  It seems to vary a lot as regards charges for this, my doctor didn't charge me, but I've heard of others who get charged for a full consultation!!
> 
> I thought medical card patients were covered by a flat fee to the doctor, not a charge per visit?



You can be sure that the form is filled in by a secretary, not the doctor.

Yes, the GP gets a flat payment per patient visit plus a payment for each house call (if they do them) plus the extra’s.


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## terrysgirl33 (23 Nov 2011)

Yes, filled in by the receptionist and signed by the doctor.


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## liaconn (23 Nov 2011)

Mpsox said:


> Personnally, as someone who grew up on a farm, I got little sympathy if I was sick, cows don't milk themselves. Strangely in 20 years working in an office I've had 3 days sickness (and I'm excluding accident related issues here), some people manage that in 20 weeks


 
Well you're either exceptionally lucky with your health or you're one of those annoying people who come into work with colds and stomach bugs and give them to everyone else.  It really annoys me when people get smug about how little sick leave they've taken. Not everyone is fortunate enough to have great health.


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## liaconn (23 Nov 2011)

Mpsox said:


> As an employer, sometime I have issues with sick notes presented to me. On a number of occassions, I've refused to accept a sick note for people who were off sick for one day and the note said "flu". (Not flu like symptoms, just flu). You don't get the flu for a day. Likewise, I've refused to accept certs which state someone is "sick", without outlining what is wrong with them.


 
My doctor refuses point blank to put the nature of your illness on a cert for work. As far as he's concerned its none of the employer's business.


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## Purple (23 Nov 2011)

liaconn said:


> My doctor refuses point blank to put the nature of your illness on a cert for work. As far as he's concerned its none of the employer's business.



Your doctor should put it on the cert if you tell them to. Who do they think they are?


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