Can you provide medical certificates outside of your training position?

You are working as an intern in a hospital when your friend asks if you can do him a favour? Can you provide medical certification for some amateur fighters to be assessed as fit to enter a boxing competition?

You wonder if this is something that you are able to do as an intern?

An intern member recently called our Medico-legal Advisory Service for advice on this dilemma, which raises two important points. Firstly, unlike medical practitioners who hold general registration, interns only hold provisional registration, and secondly, the provision of any form of medical certification needs to be taken very seriously.

What does provisional registration mean?

In Australia, all medical graduates must successfully complete an internship before becoming generally registered with the Medical Board of Australia. Your internship is a key part of the transition from medical school to independent practice and specialty training, and focuses on practical training under supervision from senior colleagues.

Interns not permitted to provide clinical care outside of their position

During your internship, you are supervised at a level appropriate to your experience and responsibilities at all times. You are not permitted to undertake any clinical work outside the allocated intern position.

Therefore, our medico-legal experts advised the intern that as he only held provisional registration, he was not permitted to provide clinical care outside the hospital without supervision and should decline to perform the pre-boxing medicals.

Issuing medical certificates appropriately

The second issue raised in the call involved providing medical certification. Medical certificates, for example, sickness certificates or certification that someone is fit to participate in sport are powerful legal documents which can entitle a person to financial or other benefits. Therefore, doctors need to be mindful of their obligations when requested to complete any form of medical certification.

In one case, a Resident Medical Officer (RMO) member issued an ‘unfit for work’ medical certificate to a friend for some sick leave from work so that he could attend a music festival. A few days later, the friend’s employer was shown pictures of their Facebook page which clearly showed him having a great time at the festival ¬¬– he certainly did not appear to be unfit for work. The employer wrote to the Health Care Complaints Commission (HCCC) alleging that the medical certificate had been provided inappropriately. The RMO received a letter from the HCCC seeking a response and a copy of the medical records that supported the medical certificate being issued.* Situations such as these potentially expose doctors to criticism and/or disciplinary action from regulatory bodies such as the Medical Council or AHPRA.

Needless to say, the RMO had left himself open to criticism and sought our advice.

Tips for writing medical certificates

• Interns can only provide medical certificates within their training position, for example, under supervision within the hospital.
• Any medical certification is best defended by good notes and where appropriate, relevant investigations and referrals, and even the opinions of other health professionals.
• For medical certificates, your contemporaneous notes of the patient’s visit should always record the diagnosis on which the certificate was issued, and the details of the history and examination findings and any other clinical information supporting that diagnosis. We also recommend that you keep a copy of the certificate in their file.
• If you do not honestly believe the patient has a medical condition which affects their ability to attend work or school, do not provide a certificate. If you do, or if you provide a certificate for longer than is reasonably necessary, you could be exposed to disciplinary, civil or even criminal actions.
• Unless required by a statutory scheme, such as WorkCover, private health information diagnosis should not be included in a medical certificate.
• The content of a certificate should be limited to the fact that the patient is unwell, unable to work, and how long they will be expected to be unable to work.

Providing care to family and friends

As a young doctor, it can be difficult to refuse to provide medical certificates when asked by family and friends, but it’s important to remember that every certificate you write comes with clinical, ethical and legal responsibilities.

Doctors have an ethical duty to act in accordance with professional standards. The Medical Board of Australia’s Good medical practice: code of conduct for doctors (the Code) outlines the conduct that is expected from doctors in Australia. A doctor will be expected to explain and justify their conduct if it departs significantly from this standard.

In relation to treating family and friends, the Code states “whenever possible avoid providing medical care to anyone with whom you have a close personal relationship.” In most cases providing care to close relatives, work colleagues and family members is inappropriate because of the lack of objectivity, possible discontinuity of care, and risk to the doctor and patient. In some cases, providing care to those close to you is unavoidable.

Whenever this is the case, good medical practice requires recognition of the above issues. You also need to remember that should something go wrong, in addition to adversely affecting your relationship with your family or friend, you may be asked to justify your decision to provide a medical certificate to the Medical Board, court or tribunal.

*This scenario has been created based on our experience.

Further information

Guidance about completing medical certificates can be found in Section 8.8 of the Code and in Avant’s fact sheet, ‘Medical certificates and your responsibilities'.

More information

For medico-legal advice, please contact us on nca@avant.org.au or call 1800 128 268, 24/7 in emergencies.