Rural GP reprimanded over ‘shortcuts and skipping steps’ when issuing medical certificates

Patients and practice workloads can put pressure on doctors to quickly issue a medical certificate. However these are legal documents and come with professional and legal responsibilities. Taking shortcuts to assist a patient or save time can call doctors’ professional integrity into question.

Dr F was a rural general practitioner. The Medical Board raised concerns about medical certificates Dr F issued for six patients.

Medical records

The board alleged that Dr F had issued medical certificates for patients after a consultation without documenting:

• that he had issued a certificate
• any contemporaneous examination of the patient
• the clinical reason(s) for the certificate.

The tribunal agreed and Dr F accepted that this conduct was below the standard expected.

Medical certificates

The board also alleged Dr F’s certificates did not satisfy the expected standard because:

• some related to absences significantly prior to the date of the certificate
• other certificates were undated
• one certificate was for extended absence for stress where Dr F ought to have considered issuing a WorkCover certificate
• another certificate was for a period of six months where there were no arrangements for regular review of the patient.

The concerns related only to the form of the certificates and procedures for issuing certificates. There was no suggestion any of the certificates were fraudulent or deceptive. The board accepted that all were for genuine absences and in all cases Dr F knew the patient’s circumstances and medical history.

The tribunal agreed the medical certificates were issued legitimately but concluded the concern lay in the shortcuts taken by Dr F, particularly in relation to inadequate record keeping underpinning the certificates. The tribunal found, and Dr F accepted, that this conduct was below standard and constituted professional misconduct.

Medical statement

There was a separate allegation that Dr F did not satisfy the expected standard by issuing a ‘Medical statement’ to a patient, detailing the patient advised they’d been unwell and unfit to attend work on certain dates.  The tribunal did not accept these actions were below the accepted standard.

The tribunal acknowledged Dr F had not certified this information but rather he simply stated what the patient had told him and made it clear in the document. Whether or not it would be accepted by an employer was another matter, but the document was not misleading and writing it was not unprofessional conduct.

Professional boundaries - treating those close to you

The board also alleged in one case that Dr F had written a certificate for a close friend or family member and allowed them to complete the dates of absence in the certificate.

The tribunal noted that Dr F had countersigned the dates added and accepted his explanation that the patient had been uncertain of the dates at the consultation and had needed to check these. The tribunal commented that this situation illustrated the risks for doctors in treating those close to them. While this conduct was below standard, it could not be characterised as fraudulent or misleading.

The independent expert, also a rural practitioner, noted that when practising in a small community:

“it is even more important that we are aware of ethical responsibilities, and how we must be extra vigilant around maintaining the professional boundaries when we see [members of our community] as medical practitioners, rather than out socially in the community. Sadly I think the lines have become very blurred in this situation….”

The tribunal noted that doctors have serious professional and ethical obligations when writing medical certificates. It reiterated their legal status, the important and trusted role doctors have when issuing them and confirmed employers and others should be able to rely on them.

Dr F accepted his conduct could constitute professional misconduct. He agreed his actions were inadequate. Prior to the tribunal hearing, he had undertaken one-on-one education and made substantial changes to his practice.

The tribunal noted there was no suggestion of fraud or dishonesty, Dr F had cooperated with the investigation and demonstrated candour and understanding throughout. It also acknowledged he was providing an important role in the health care of his community and that in all circumstances, suspension would be disproportionate.

The tribunal specifically recognised the pressures facing many rural and remote practitioners and their critical importance to the communities they care for, especially when already experiencing shortages. However, it noted that this does not exempt them from the same professional and ethical obligations as those in metropolitan settings and in fact makes it even more important that they remain practising and do not ‘blur the lines, take shortcuts, or otherwise put their professional obligations last and their registration in jeopardy.’

Dr F consented to orders that he be reprimanded and subject to three-monthly practice audits for at least two years.

When issuing medical certificates, always ensure these are based on your clinical assessment, supported by appropriate history and examination findings. Even if you’re assessing the patient via a telehealth consultation (for example, because the patient is infectious), it is still important to gather information from the patient and ensure you are satisfied it is appropriate to provide a medical certificate. See Avant’s factsheet Telehealth essentials.

Always document the results of your examination and the reasons for issuing a certificate in your notes for the consultation. Keep a copy of any certificate you issue in the patient’s records.

Never provide a certificate with blank dates or allow anyone else to complete parts of the certificate.

A medical certificate must always clearly show the date it was written.

You can provide a certificate for an illness that began prior to the consultation, as long as you are confident that the certificate is warranted. Never backdate a certificate or suggest that you examined the patient on a different day.

Be cautious about issuing certificates for long periods. Consider whether it is more appropriate to write a certificate for a shorter period and review the patient’s situation if the incapacity or illness persists.

Wherever possible avoid treating or providing medical certificates to anyone with whom you have a close personal relationship.

Avant factsheet – Medical certificates and your responsibilities

Avant factsheet – Treating family members, friends or staff

Medical Council of NSW – Guideline for self-treatment and treating family members

Avant article – When it is hard to say ‘no’

Avant factsheet – Medical records: the essentials

Avant factsheet – Telehealth essentials

For medico-legal advice, please contact us here, or call 1800 128 268, 24/7 in emergencies.