Justifying a legitimately-issued medical certificate

Originally published June 2020, updated June 2024 by Dr Hirruthyaa Manivasagan, MBBS FRACGP DCH, Medical Adviser and Claims Manager and Adjunct Associate Professor Julie Brooke-Cowden, BSc LLB, LLM, General Manager Professional Conduct Claims.

Medical certificates are powerful legal documents. If they are challenged, they may be subject to scrutiny by the Medical Board of Australia. Therefore, it is important doctors are fully aware of the legal and ethical obligations that come with signing a medical certificate. 

In one case, a GP member issued a medical certificate to the spouse of a patient who was listed as her husband’s carer. Her husband had aplastic anaemia, was immunosuppressed, and awaiting a bone marrow transplant. 

During her consultation with the doctor the spouse requested a medical certificate. She worked one day a week in the kitchen of a nursing home, which had an outbreak of influenza, and was concerned about the possibility of exposing her husband. The doctor was aware of the high rate of influenza cases in the community, even with the uptake of the vaccine. In these circumstances, the doctor felt it was appropriate to provide a medical certificate. With the consent of the husband, his health information was disclosed on the medical certificate. 

The employer complained to the Medical Board about the doctor writing inappropriate medical certificates, and they received a letter from the Board requesting a response in relation to the employer’s notification. The member contacted Avant for assistance. 

Avant assists doctor’s response to the Medical Board

A solicitor from Avant Law Medical Indemnity was instructed by the claims manager to assist the member to draft a detailed response to the notification. It was explained the certificate had been issued to the spouse on the basis that she was an at-risk person’s carer, and it was reasonable that she did not wish to enter her workplace when there was an influenza outbreak. Further, the response also suggested it was inappropriate for employers to challenge medical certificates as a way of airing employment grievances by going to the Medical Board and submitted that the notification should be dismissed. 

The doctor’s conduct was found to be entirely appropriate, and the notification was dismissed as “frivolous, vexatious, misconceived and lacking in substance” under section 151(1)(a) of the National Law.  

How can these situations be avoided?

Medical certificates are regarded as legal documents. Doctors may be subject to disciplinary action for providing deliberately false, misleading or inaccurate certificates. Unfortunately, it is not uncommon for employers to utilise the complaints process to question medical certificates where there is an underlying employment relationship problem, or they consider there is insufficient justification for a certificate to be provided. In response to any complaint, the Medical Board focuses heavily on clinical justification. That is, was there a legitimate clinical basis for issuing the certificate for a period of time that is also clinically justifiable? When responding to notifications, the Medical Board expects doctors to have practised in accordance with Good medical practice: a code of conduct for doctors in Australia and professional guidelines such as the AMA’s guidelines on medical certificates. As always, thorough clinical records which support the clinical indication or reasonable justification for issuing the medical certificate will provide the strongest defence against any accusations of improper conduct. 

In this case, the Medical Board accepted the practical necessity for the medical certificate to be provided for leave. 

Rather than complain to the Board, some employers may seek clarification of a medical certificate directly from the doctor. When employers approach doctors to justify a patient’s medical certificate, protecting the patient’s privacy is essential. No further medical information should be given to a patient’s employer without first verifying the employer’s identity and obtaining the patient’s consent to disclose. If there is a suggestion a patient may have altered the medical certificate by changing dates or other information, it is reasonable for a doctor to review the certificate provided to the employer and confirm the accuracy of the certificate. 

Useful resources

Guidance about completing medical certificates can be found in Section 8.8 of Good medical practice: a code of conduct for doctors in Australia and in Avant’s factsheet, ‘Medical certificates and your responsibilities’. 

If you have concerns about completing a medical certificate, email us on nca@avant.org.au or call 1800 128 268, available 24/7 in emergencies.