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Your first... suspected skiver

Sooner or later you will be asked for a sicknote by someone who seems perfectly well enough to work, writes Dr Melanie Wynne-Jones

Sooner or later you will be asked for a sicknote by someone who seems perfectly well enough to work, writes Dr Melanie Wynne-Jones

The doctor-patient relationship is supposed to be based on mutual trust so we don't like it when we feel someone is being economical with the truth. However, rather than deliberately lying, patients may simply have a different view of the world.

Some take an unusually long time to get over minor self-limiting complaints; self-certification for seven days was designed to reduce consultations for these. Many longer-term complaints such as musculoskeletal pain or stress can be subjective, and some patients struggle on despite significant suffering, while others need a sicknote.

However, patients occasionally lie for personal gain – to arouse sympathy, manipulate others, obtain medication, take time off work, avoid criminal proceedings or other responsibilities.

The Department of Work and Pensions (DWP) states that 'doctors should always consider carefully whether advice to refrain from work represents the most appropriate clinical management....medical statements are official documents and may be used by a patient as evidence to support a claim to a financial benefit – it is therefore very important that statements are completed in accordance with DWP guidance which is based on the relevant law'.

You must enter an accurate diagnosis on a medical certificate (form Med 3 or 5) to enable the Benefits Agency's Medical Officer to identify patients suitable for exemption from the appropriate test of incapacity for work.

If you suspect your patient is probably fit to work, you have several options:

  • Direct challenge/confrontation. This may succeed, but if you are wrong or unable to prove your suspicions, you may trigger a complaint or even assault, or destroy the doctor-patient relationship. It may be wiser to obtain more information and advice first
  • Dig deeper and explore the patient's ideas, concerns and expectations. This may uncover previously unsuspected disability, depression, bullying, or unsuitable working conditions. A sicknote may actually be appropriate; the patient may also need referral to a specialist, a counsellor or occupational health. Solutions may include a graded return to work, light duties, a change of department/line manager, or adjustment to the working environment
  • The DWP offers local support services to patients who are not working because of a medical condition or disability, including the Employment Services Disability Service, which may assist the patient to get back to work or explore alternative employment. You can ask for its help in the 'remarks' section on a Med 3, or write to the local Jobcentre or Employment Services office (patient consent is required)
  • You can request 'a second opinion regarding the patient's fitness for work', without giving a reason, using form RM 7 (supplied with Med 3/5 forms). Send it to the local Benefits Agency office which will take appropriate action

Melanie Wynne-Jones is a GP in Marple, Cheshire

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