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Am I obliged to give firms an occupational health opinion?

We are receiving increasing requests for occupational health reports on patients relating to sickness absence from work. The company generally seeks an opinion on the employee's fitness for the job, any limitations that should apply and possible adverse effects of continuing in the job. I am not qualified in occupational health and do not feel happy giving such opinions. However, several of the companies have implied that my duties as a GMC registered doctor oblige me to do so in order to act in my patient's best interests. What is your advice?

If you do not feel competent to give what is effectively an expert opinion you should not do so, however much pressure is exerted.

There is nothing in the terms of service that requires you to provide an occupational health service for your patients, and it may be contrary to your patient's best interests to do so!

The GMC is specific in the advice it gives relating to the duties of a doctor registered with the council. It states quite categorically that you must recognise the limits of your professional competence and that you should work with colleagues in the ways that best serve patients' interests.

The company which is the subject of your question should provide a proper occupational health service by employing a trained occupational health physician, by using the private services of a GP with the appropriate interest and expertise or by using a company specialising in the provision of occupational health services.

If you wish to provide a report based upon facts, rather than an opinion, you may do so with your patient's fully informed and valid consent. You may alternatively provide the patient with a copy of the relevant clinical notes.

The patient may then choose whether or not to provide this data for his or her employer. Employees should generally refuse to provide confidential medical information to anyone except another doctor trained to assess its relevance to the patient's employment.

Once you offer a subjective opinion on the patient's fitness to work in a specific job you are placing yourself at risk of subsequent legal action if your opinion has an adverse effect on the patient's employment prospects.

Dr Christine Dewbury, Wessex LMCs

Neither Pulse nor Wessex LMCs can accept any legal liability in respect of the answers given. Readers should seek independent advice before acting on the information concerned.

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