A DOCTOR WRITES: Absenteeism needs an imaginative approach that respects the rights of genuine cases
THE CALL by the Isme on doctors to be more circumspect in issuing sick certificates raises some interesting societal issues.
While the survey details have yet to be published by Isme, it seems reasonable to assume that its statement that “companies indicated that, in their opinion, some 83 per cent or five days of unauthorised time taken was due to feigned illness or malingering”, is based on a direct question to the 750 companies surveyed. However, it will be interesting to examine the detail of the survey to ascertain whether malingering and doctors’ sick-note practices were in fact linked as “cause and effect”.
The frustration of Isme echoes a recent debate in the UK, when the health secretary, Alan Johnson, said he was keen to change what he termed the nation’s “sick-note culture” into a “well-note culture”. “Incapacity benefit should not be a one-way street that starts in the GP surgery and ends as a lifetime on benefits,” he said last year.
But GPs do not want to police people over their capacity to work.
Understandably, they argue that such a role would seriously damage the ongoing doctor-patient relationship. Some GPs feel that sick certification turns them into social benefit gamekeepers. A 2004 Scottish study on the views of GPs regarding sickness certification found that almost all doctors felt a strong conflict of interest given that their primary responsibility was to the patient.
In 2007, Dr Noel Howard, Dr Liam Glynn and Dr Michael McGloin of the Western GP Training Programme surveyed 245 GPs in the HSE western area on certification practices. Just four per cent of GPs said they often give a sick cert for social reasons, such as for the care of a sick relative. But some 80 per cent of respondents said they used certificates in the management of work-related issues such as bullying or stress.
When GPs were asked what strategies they used when faced with a situation where they found it difficult to justify the continuation of such certification, most said they would confront the patient. Referring the person to a colleague or formally requesting a review by a social welfare medical adviser were alternative options. Writing in the Journal of the Irish College of General Practitioners, the authors of the study recommended the State carry out a trial of self-certification to see how this would affect sickness absence.
Doctors in the Republic issue two types of sickness certificate: a private one for employers and a social welfare medical certificate for which they are paid by the Department of Social and Family Affairs.
Departmental guidelines are clear: “If the patient is capable of work, he or she [the doctor] should refuse to issue a certificate”. And where GPs are in doubt about a person’s capacity to work they are asked to refer the patient to the department’s chief medical adviser.
At a time of economic uncertainty, reducing absenteeism is a laudable goal.
But legitimate sickness absence must be protected. Alternative approaches, such as self-certification and an increased role for occupational physicians and company doctors, should be explored.