Medical Council of New Zealand - Updated Standards for Doctors Writing Medical Certificates
As of October 30 2013
The Medical Council today released its updated standards for doctors writing medical certificates.
Medical Council chairperson, Dr John Adams says that the writing of medical certificates can be a complicated part of medical practice. It is an area of practice where doctors have responsibilities to a third party, such as an employer, in addition to their primary obligation to care for their patient.
‘Doctors in writing a medical certificate certainly need to be mindful of the implications for the patient, themselves, and the agency receiving the certificate.’
’Medical certificates may have financial implications for the patient and the recipient through benefits, employment and compensation payments and failure to complete a certificate appropriately may have a negative impact on the patient, the patient’s family or the receiving agency (for example, in the case of sick notes, the patient’s employer).’
’In addition, a doctor who certifies a patient to undertake work when he or she is unfit may place the patient or the patient’s colleagues at risk,’ said Dr Adams.
The Council’s new standards state medical certificates should provide the necessary information required by the receiving agency and consented to by the patient. The ‘necessary information’ should usually be limited to information about the doctor’s clinical opinion on safe activities / restrictions and timeframes. The certificate should not include private or irrelevant information.
A doctor should not usually record a diagnosis in a medical certificate, unless this has direct implications for the receiving agency. Examples of where a doctor should seek a patient’s consent to include a diagnosis in a certificate includes where the diagnosis relates to a workplace injury or illness and where the employer might need to take action to prevent a recurrence, or where the illness or injury may have an impact on co-workers and the public and the medical certificate is to be received by the patient’s employer (for example, where a chef is diagnosed with a food-borne illness).
Any comments on fitness for work should refer specifically to the doctor’s clinical opinion, outlining those activities that are safe for the patient to undertake and appropriate restrictions, or unsafe activities, that the patient should not undertake. If the patient is fit for some activities, this should be recorded in the certificate. Any duties that should not be attempted should also be clearly stated.
Dr Adams said, ‘Often employers or other agencies may seek additional information from a doctor about a patient’s health status and whether they can work, together with the number of hours a patient may be able to work
’In these situations, our statement suggests employers or other agencies ask for the doctor’s clinical judgement as to what work the patient is fit for together with the number of hours a patient may be able to work.’
’However, the doctor’s ability to provide this type of information will be limited if the patient has not consented to its release.’
Dr Adams says that if employers and other receiving agencies are concerned about the content of a medical certificate then they should seek the patient’s consent and approach the doctor who issued the certificate with their concerns. If the doctor’s response does not meet their needs, then they might consider asking the patient to see another doctor to obtain a second opinion. If you are concerned that a doctor has not complied with the requirements of the Council’s statement, you can lodge a complaint with the Medical Council or the Office of the Health and Disability Commissioner.