Medical Certificate Sting

Not sick but you want the day off? No worries. These doctors are happy to make every weekend a long one…just ask and they’ll give you a certificate.

Channel Nine, A Current Affair, 2nd October, 2013

This was the introduction for A Current Affair’s television show last month when they exposed the ‘scandal’ of doctors liberally writing medical certs. GP Liam Carroll, who featured in the show had every right to respond by saying that selective editing has tried to make him look like a clown.

He was not happy. I’m fuming too.

But what does this mean for us as doctors, and why are the media trying to string us up?  Are we really still living in a period where mental health problems are seen by the press as trivial?

In case you’ve missed it, as part of an ‘undercover investigation’ into medical certificates, the producer of A Current Affair went to five different GPs, pretending to be a patient, to see how easy it would be to get a medical certificate. He went in with his ‘girlfriend’ and secretly recorded the consultation.

His reason for a medical certificate was that he wanted a day off work due to tiredness, stress and difficulty with his boss.

Out of the five GPs he saw, they all wrote him a medical certificate. Scandal? Well, not quite; unless you employ some shifty editing.

The edited version of Liam Carroll’s consultation (which went on air) showed him joking with the patient,

“What excuse will I put in? Girlfriend took him out for lunch?”

“Yeah, ha ha.”

In reality, the full version of the consult was actually very good indeed. This jovial intro merely served to set up a good, non-judgemental relationship with the patient. Dr Carroll then spent some time trying to find out what the real issue was; if there was anything more sinister going on; and suggesting options for psychological counseling.

The whole episode raises some questions.

What would you do if a patient recorded your consultation? In the SoMe age, it’s a very real possibility – don’t patients have the right to put these things in the public domain? I once had a patient who kept a blog of their hospital stay – a blow-by-blow account of every encounter with medical staff and how they felt about us. And they didn’t hold back. It was strangely compelling reading – wondering if you’d be mentioned but, at the same time, terrified if you were. In the end I stopped reading it until they’d been discharged. It was easier that way.

A patient has previously asked to record me carrying out a procedure or rather, just happened to have their camera rolling nearby while I tried to cannulate their neonate. I kindly asked them to turn it off. After all, we need to feel comfortable, otherwise that has an impact on the care we are providing to our patients.

Of course, in Carroll’s case, it was all cloak and dagger. They weren’t recording to preserve the memory, they were clearly trying to stitch us up. The question is why?

For me, the issue is clear – if a patient is bothered enough to come and ask you for a certificate, they probably have a pretty good reason. Carroll, in his response, has highlighted the difficulties with recognizing mental health problems, and the risk of suicide in male patients. Although A Current Affair considers this not to be a medical problem, of course it is.

It is impossible to gauge levels of stress from one short consultation – if someone comes to ask you for help, then you should do your best. At the very least you will be leaving the channels of communication open for them in future, rather than turning your back and telling them that their problem isn’t ‘medical’.

The media should be supporting us on these issues. They should not be trying to poke fun at us. They should not be aiming to make us look incompetent. And they should not be trivializing work-based stress.