Editor—No one is in a better position to issue a sickness certificate than a general practitioner.1 He or she has the information at hand and sometimes good knowledge of the patient. Independent examination would be an unmanageable system with constant requests for the general practitioner's opinion and records.
My role in sickness certification has made me realise that general practitioners are not patient advocates but an essential part of society's machine. People need somewhere to go when they are ill or believe themselves to be ill or even if they are swinging the lead. As general practitioners we are an essential part of the system that tries to ensure people are using the country's resources appropriately. The government drops our gatekeeping role at its peril.
The ability to negotiate a sick note and to know how to balance what is best for the patient—for example, perhaps not adopting the sick role—and what is best for the system is a huge responsibility and intellectually quite challenging if thought through in terms of the patient and society.
A lack of ability to confront patients is a deficiency in general practitioners' skills. The epidemic of illness behaviour and sick role adoption is partly our fault.
Competing interests: None declared.
References
- 1.Hussey S, Hoddinot P, Wilson P, Dowell J, Barbour R. Sickness certification system in the United Kingdom: qualitative study of the views of general practitioners in Scotland. BMJ 2004;328: 88-91. (10 January 2004). [DOI] [PMC free article] [PubMed] [Google Scholar]