Sickness certification system in the United Kingdom

Editor—Doctors are agents of social control and get paid accordingly. And you'd better believe it because it ain't about to change.

A cold ain't a cold until you say it is. A person ain't fit to drive until you say they are, and nobody ain't fit to go back to work until you say they are.

Enter the patient. There are the driven folk, those without insight, who want you to look under the bonnet, twiddle a few knobs, and send them magically repaired back on their way. These are the people you encourage to take time off work because it's all you can do, and often they take no notice.

Then you have the amorphous dispossessed. Those who have to work and don't feel up to it; those who experience the drudgery of manual work when there is depression or pain; those out of work and under pressure to take jobs that are even worse than the ones they've lost. These people create the dialogue of uncertainty that is so accurately illustrated in Hussey et al's paper.¹

Figure 1.

GPs are in best position to issue sickness certificates

Credit: JOSH SHER/SPL

In the face of this uncertainty we create terms and phrases that obfuscate. We write sick notes unthinkingly and inconsistently, doing so with good grace for those we like and more grudgingly for those who make us feel angry or uncomfortable.

There is anarchy in all this that we rather enjoy, but we do so irresponsibly. In one of the focus groups a doctor had written nothing in the space provided for diagnostic detail and boasted that in four months no one had taken him to task for it.

This is the point: there is no redress for anything you write, but imagine the chaos you can create for the honest employer, the small business with a shoestring workforce stripped of a couple of indispensable workers for two weeks.