From The Times 1/1/2004
College defends doctors over sickness certificates
Fiona Galea Debono
The Malta College of Family Doctors said it had been "distasteful" of the department of social policy to vilify GPs when it knew that the issue of sick leave certificates was complicated.
Referring to an article in The Times about "warning letters" sent to 200 doctors for issuing an excessive number of sickness certificates to certain patients for the same condition, the college said it has been receiving complaints from many doctors regarding the letters. The complaints have also been forwarded to the Medical Association of Malta.
The government had also analysed the income declarations submitted by doctors and found that a significant number of GPs, especially those who have issued an alarming number of sickness certificates, were declaring "very little income", The Times article had said.
But the college said yesterday "only amateurs would try to associate declared income. Doctors are obliged by law to issue a certificate only when they have examined a patient. They usually follow up on their patients on a weekly basis, or more, but there is no strict rule".
While it was impossible to guarantee that every individual was acting professionally, the doctor-patient relationship was based on trust, it said.
"The law recognises doctors moving on sound moral grounds. Patients do not always need to see a doctor for illnesses such as common colds and it is not fair to oblige them to spend money on a house call or not to certify their sick leave. In instances of long sick leave, such as for boarding out from work, or convalescing from fractures and operations, patients need not see doctors and pay consulting fees every week.
"If patients want to breach the trust, it is their prerogative. The doctor cannot always detect malingering. If one starts mistrusting patients, one breaches the fiduciary nature of the doctor-patient relationship. A doctor needs clear proof before he can legally and morally override the principle of respect for autonomy."
The college explained that the practice of issuing consecutive certificates is easily broken simply by not issuing certificates bearing consecutive numbers and is, in fact, a sign of the good faith doctors have in the department of social policy as understanding the nature of their work.
"Such trust is obviously not reciprocated. It would be prudent to promote dialogue to see how we are going to solve our primary health care problems," it said.
Figures obtained by the government, which were also shown to the MAM, indicated that, between them, the doctors issued over 170,000 sickness certificates in eight months.
Over 90,000 of the certificates were issued to employees in the private sector and about 80,000 certificates covered public service employees.
One particular doctor issued more than 3,500 sickness certificates in eight months, sources had told The Times, adding that the government would take action if the pattern persisted.
Four of the 200 doctors issued more than 2,000 sickness certificates each and one particular doctor issued 22 consecutive certificates to the same person for the same condition.
The data also showed that the number of sickness certificates peaked in the hunting season.