Practice dilemma: Gym certification
A patient asks you to sign a certificate guaranteeing their fitness to exercise at their new gym. Are you obliged to do so?
The benefits of exercise are well known and doctors frequently encourage patients to participate.1 This is consistent with doctors' duty to encourage and support patients to act to improve and maintain their health.2 Hence doctors often receive requests to confirm a patient's fitness to exercise, which naturally cause concern about potential liability for subsequent illness or injury.
Without a crystal ball it is impossible, based on the limitations of any assessment a GP can perform, to be able to guarantee a patient's fitness, especially as patients might have conditions which are undiagnosed and undiagnosable. For example, normal ECGs can coexist with significant heart disease.
Some doctors may be reluctant to certify a patient's fitness and there is no obligation on them to do so. However, many wish to support their patients in taking steps to benefit their health by accurately reporting, following appropriate assessment comprising records review and a relevant history and examination, that they not aware of any condition that would prevent exercise participation. It is at the doctor's discretion whether they charge a fee for such a report.
If a patient suffers from conditions that could impact on their ability to exercise safely, MPS recommends disclosure, with patient consent, of any relevant medical conditions and medications, to enable gym staff to devise suitable exercise programmes and to seek appropriate assistance should a patient fall ill or sustain an injury at the gym. It then falls to the gym to decide what weight to place upon the information provided.
Dr Helen Hartley is a medicolegal advisor, based in London, for the Medical Protection Society
1 Department of Health, 2001. Exercise Referral Systems: A National Quality Assurance Framework (NHS)
2 General Medical Council, 2006. Good Medical Practice