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Dealing with a colleague who wants you to bend the rules

A colleague from the local hospital approaches you about his wife and children's plans to visit family in Kuwait. He phoned to say that because of the political situation and the threat of war in the area his wife wanted to cancel the trip, especially as the children were involved. But if they cancel they stand to lose more than £1,200 on the tickets. He asks whether you could give his wife a medical certificate to say she is unfit to travel, so they can claim off the insurance.

Your colleague's wife is a bit of

a worrier, but she hasn't seen

you for over a year, and it would be hard to describe exactly why she is unfit to travel on any certificate, other than 'chronic worry'. It is doubtful whether this would convince the insurance company.

On the other hand you do not want to offend your colleague who, as well as bending over backwards to get the best deal for patients, is a regular golf partner and friend.

Case history

Three GPs discuss a difficult dilemma in general practice

Dr Patrick Clarke

'Clearly I'd be unable to give any false information'

I am particularly interested in this situation as I spent the first 10 years of my life in Kuwait, though I dare say I would no longer recognise the place. As for the case, the colleague would be putting me in a difficult position. Clearly, I would be unable to give any false information on the insurance form.

There are a number of alternatives that may help my colleague out of the situation. It would be worth him getting in contact with the insurance company to see if there is a clause where the family can claim the money back in the event of a war or civil unrest. If there was guidance from the Foreign Office, this could be used to back up the claim. There seems to have been considerable political changes since the time of booking. If there are members of family in Kuwait, they could approach the tour operator to see if they can transfer the names on the tickets in order to fly other family members home. Another possibility would be to see if the tour operator was prepared to exchange the holiday for a less war-torn part of the world!

If none of the above ideas were feasible, I would discuss the situation informally with my colleague. Are there any medical reasons that the children would be unable to travel? I would explain to him that I would be unable to put a suitable reason for his wife being unfit to travel. The colleague would not expect me to be dishonest.

I would do my best as a friend to help him come up with some alternatives. In fact, I feel that in this situation, I would be dealing with him more as a friend than as a doctor.

Dr Simon Brown

'Perhaps this is the sort of friendship I don't want'

Despite advocacy for patients, this may be pushing me too far. My colleague is explicitly suggesting I write a medical certificate that at best is a half-truth. This could certainly be seen as a fraudulent act and one that the GMC would regard as unprofessional. At the same time a blunt refusal would almost certainly offend; I need more information first.

It seems impossible to comply with his request without at least some dialogue with my patient, this man's wife. I haven't seen her for a year, so a request to consult with her is unlikely to cause surprise. I would contact her directly and suggest an appointment in surgery. Her chronic worry may have developed into an overt clinical depression perhaps precipitated by the imminent stress of travelling to see family who are themselves at risk.

If this is the case it may be possible to write a certificate based on an appropriate, recent and honest medical assessment. Even if the insurance company isn't convinced, at least I will have complied with the original request.

If, as I suspect, my patient were actually well apart from some understandable and appropriate anxiety at cancelling an expensive trip it would be impossible for me to write a medical certificate. As a profession we are rightly expected to maintain high standards of probity. I have learned a little more about my friend in his request to me to commit a dishonest act.

Despite the benefit to patients from having a friendly contact at the hospital, and to myself from a pleasant golfing companion, I may have to forgo them if my colleague maintains his original request. Perhaps this is the sort of friendship that I don't really want.

Dr Lucy Free

'I'd be happy to help in any way I can ­ short of perjuring myself'

I feel sorry for this chap: what can his home life be like if this is the situation shortly before they are due to leave, even if his wife's fears do seem irrational? And what sort of holiday would it be if they did go? I would be happy to help in any way I could, short of perjuring myself.

These are difficult times for doctors and we should support each other ­ heaven knows, there are few enough perks to the job!

What he is asking will have been difficult for him, but is no different from the other bizarre conundrums with which patients present to us every day.

I'm sure he would have considered the other options: selling to a compatriot, exchanging for vouchers and so on, and has come to me as a last resort. The challenge will be to present it to the insurers in a justifiable way, and the time-frame makes that tricky, as I wouldn't want to condemn them to never being able to fly anywhere ever again.

I would agree to help, but delay the details. If the situation deteriorates and the Foreign Office advises caution, then legitimate cancellation results anyway. And there's always the possibility his wife may change her mind if she's that volatile.

But if push came to shove, I'd fill the form in with some minor unchallengeable excuse like death of a pet or a sprained ankle. After all, what are friends (and what is insurance) for?

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