Abstract
As well as acting as personal physicians, general practitioners are often asked to provide medical certificates, enabling patients to obtain benefits. In these cases doctors may act for the state, for other institutions or individuals, or as an advocate on the patient's behalf in a dispute. The ethical basis of this activity differs from the therapeutic doctor-patient relationship. Difficulties are particularly likely to arise when doctors are called on to combine the roles of therapist and certifier. Although this is often convenient and saves money, the damage to confidentiality and to the primary therapeutic relationship which may result must be weighted against this. The limitations of such certificates should also be borne in mind. Fairness and the preservation of the therapeutic doctor-patient relationship are best served by restricting the role of the personal doctor to the provision of clearly defined factual information on which others, who may be medical or non-medical, can make the final judgement.
Full text
PDF


Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Coe J. The physician's role in sickness absence certification: a reconsideration. J Occup Med. 1975 Nov;17(11):722–724. [PubMed] [Google Scholar]
- Lorge R. E. How informed is patients' consent to release of medical information to insurance companies? BMJ. 1989 Jun 3;298(6686):1495–1496. doi: 10.1136/bmj.298.6686.1495. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Murfin D. Medical sickness certification: why not review the role of the general practitioner? Br J Gen Pract. 1990 Aug;40(337):313–314. [PMC free article] [PubMed] [Google Scholar]
- Toon P. D. Defining "disease"--classification must be distinguished from evaluation. J Med Ethics. 1981 Dec;7(4):197–201. doi: 10.1136/jme.7.4.197. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Toon P. D., Jones E. J. Serving two masters: a dilemma in general practice. Lancet. 1986 May 24;1(8491):1196–1198. doi: 10.1016/s0140-6736(86)91170-0. [DOI] [PubMed] [Google Scholar]
