Sickness certification system in the United Kingdom

Editor—It seems sick certificates stimulate the same concerns the world over,¹ I have worked in the United Kingdom, Australia, and now in Canada. Sick certificates (and their grander cousin, the “insurance form”) particularly seem to challenge the relationship between patient and doctor because it is often a third party that demands them and not the patient. If we are honest with ourselves, how much is “time off work” part of the treatment plan for a patient? When providing certificates we are, as mentioned by one respondent, more often being policemen for employers, not doctors for our patients.

From another angle we also must be mindful of the potential harm we can do by providing a sick note “just because the patient demands it.” We certainly don't provide benzodiazepines or opioids on the basis of the same premise. Any professional relationship that is based on fear of losing the patient or just “giving them what they demand” is dysfunctional and needs to be terminated anyway.

And what is my cop out solution? Here in Canada I am free to say to the patient that unfortunately their government medical cover does not include the cost of sick notes and there is a charge for them. (Actually, I believe the same applies in the United Kingdom, does it not?) Very quickly the certificates seem to become far less necessary when they are not free.