Misuse of medical certificate by parent leads to a complaint

Providing a medical certificate for childcare to a parent is not an unusual request but, if the parents are separated, it can be misused, as one GP member found.

The doctor made a home visit after a mother raised concerns about injuries on her child following a custody visit with the child’s father. The doctor conducted a thorough examination of the patient, objectively describing a 1cm reddish inflammatory mark on the right lower chest and a 1cm superficial abrasion on the back of the right elbow. He reassured the mother the injuries were not suspicious, and no further treatment was required. His findings were clearly recorded in his notes.

The doctor also agreed to provide a medical certificate for the child after the mother requested it for childcare. The certificate stated the consultation date, objectively recorded the findings of his examination, and noted that the child was otherwise active and alert.

Unbeknown to the doctor, the mother then used the certificate to suggest the child was unable to visit his father. The father complained to the state’s complaints body and the matter was referred to Ahpra.

Caution proposed

The Medical Board of Australia reviewed the matter and proposed to caution the doctor for providing the certificate. While the Board accepted the consultation was appropriate, and he had accurately recorded his findings in his notes, the Board argued the certificate was completed without sufficient evidence of illness.

The Board said medical certificates should only be issued when a patient has demonstrated a lack of fitness to participate in relevant activities. Also, that the certificate should specify the date when they are or were unfit for attendance.

Incorrect assumptions

Avant’s medico-legal experts helped the doctor prepare a response to the Board. The response clarified the Board was mistaken in assuming the purpose of the medical certificate was to facilitate the child not seeing his father.

We argued the doctor had not certified the child was unfit to see his father, and the certificate did not suggest this. Furthermore, it could not be concluded the certificate had been written without sufficient evidence of illness. The certificate was consistent with the contemporaneous medical records and clearly and objectively stated the date of the examination and the child’s condition the doctor observed. The physical examination findings were also included.

Scope of responsibility

While the certificate complied with the Medical Board code of conduct, the Board was concerned the doctor should have reasonably expected the mother would use the certificate against the father.

We submitted this was unreasonable as the conduct of the child’s mother was beyond the doctor’s control. The certificate could equally support the child seeing his father because it does not suggest the child was unfit to do so, and stated the child was active and alert with normal vitals. Either potential use of the certificate was beyond the doctor’s scope of responsibility.

The doctor was responsible for ensuring that what he had written was accurate and consistent with his clinical observations, which it was.

We stated he had concisely documented his clinical observations to match what was in the certificate and the provision of the certificate was reasonable, appropriate and to the standard one would expect of a GP. Subsequently, the Board took no further action.

Key lessons

It is important that doctors remain objective when completing medical certificates, and ensure the records are consistent with the information documented on the certificate. A lack of supporting information and objectivity may leave you vulnerable to an accusation of unprofessional conduct.

If it is unclear what the purpose of the certificate is, it is appropriate to make further enquiries about why it is being requested and how the patient intends to use it.

Doctors also need to remember their obligations regarding the provision of medical records as stated in paragraph 10.9 of the Medical Board code of conduct. The community places a great deal of trust in doctors who have the authority to sign documents such as medical certificates, on the assumption they will only sign statements they know or reasonably believe to be true. The code states good medical practice involves:

• Being honest and not misleading when writing reports and certificates, and only signing documents you believe to be accurate.
• Taking reasonable steps to verify the content before you sign a report or certificate and not omitting relevant information deliberately.
• Preparing or signing documents and reports if you have agreed to do so, within a reasonable and justifiable timeframe.
• Making clear the limits of your knowledge and not giving opinion beyond those limits when providing evidence.

Medical certificates must clearly show the date and be written on the day of examination, not backdated or post-dated. You can provide a certificate for an illness that began prior to the examination, provided you do not backdate the examination. The certificate should objectively record your clinical findings, if necessary, and the patient consents to it being included, and your detailed medical records should support this. If the certificate is based on information obtained from another source, for example, the patient, you should also note this in your medical records.

If you do not feel comfortable providing a medical certificate, then you should not do it, or as in this case, limit the scope of the certificate to your objective clinical assessment.

Useful resources

Guidance about completing medical certificates can be found under Section 10.9 of the Medical Board Good medical practice: a code of conduct for doctors in Australia and in our factsheet: Medical certificates and your responsibilities.

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