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Dilemma: Your patient forges a doctor's letter

The local college has received a signed doctor’s letter from one of their students, purporting to be from you, but whose authenticity they doubt. They fax it to you, and you see that it is a forgery but that the student is one of your patients. How should you proceed?

Discuss with a senior officer at the college - this calls for an SEA

Dr John Canning

This forged certificate has been used to try to make a gain, such as an attendance payment, or advantage in an examination. This would be a breach of Section 2 of the Fraud Act; conviction could lead to imprisonment, even more significantly any conviction or caution means a life long ‘positive’ CRB/DBS.

Does the GP have a duty to society? I believe there is such a duty, but this needs to be managed carefully. The primary victim here is the college or examination board and you should discuss with a senior officer their policy on dishonesty. They will either want a statement from you or to refer the matter to the police for investigation.

You have a public duty to assist and should provide, without charge, a factual statement on request about the veracity of the certificate. You may come under pressure to release medical information. This may be a difficult decision and should take advice from a senior colleague, the LMC or your medical defence organisation (MDO) before responding.

You may want to contact the patient concerned, always assuming the person is registered with your practice.  I would urge you not to as this may prejudice any investigation underway which may also be wider than the single case.

Finally where did the student obtain the letterhead?  Was it made up, simply a copy of yours, was it stolen from a consulting room, or might there be someone in the practice whose honesty needs to be questioned?  A significant event analysis is required.

Dr John Canning is a GP in Middlesbrough and secretary of Cleveland LMC

Adopt a light touch and invite the patient to come and see you

Jim Sherifi - online

I am making the following assumptions: the man involved has been recently seen in our surgery and is unrelated to any member of staff.

This scenario does present a rather interesting ethical conundrum. On the one hand a serious crime of theft and fraud has been committed while on the other hand I have to be careful not to fall foul of GMC rules on patient confidentiality and the law regarding the Data Protection Act. Thus my initial response would be guarded, explaining my duty of doctor/patient confidentiality, in order to buy some time to consider my actions.

A light touch is needed. The lad is young, probably acted out of desperation and life is all about making and learning from mistakes. A degree of proportionality is appropriate and this crime does not warrant police involvement.

My next step would be to invite the perpetrator to come and see me in the surgery in such a way that a refusal would not be an option. I would confront him in a non-threatening manner on what appeared to be the facts and invite his comments on why he had taken such action. Any background issues would need to be explored further. My sentiment would be to accept any remorse shown and to suggest that the matter should not be taken any further.  I would seek his consent to try and intervene on his behalf with the college with the recommendation that he receive closer mentoring.

The discerning reader will have noted that I have not involved an MDO. As a rule I find that they tend to turn a problem into a crisis.

Dr Jim Sherifi is a GP in East Bergholt, Suffolk

Be careful not to breach confidentiality

Phil Zack - online

You will need to establish if the forgery is a genuine medical certificate which has been altered or a completely fabricated certificate: in either case you can confirm to the college that you have not issued the certificate in the form in which they showed it to you, without breaching the patient’s confidentiality. However you should avoid making any further comment on the form and not discuss anything relating to the patient. Even confirming to the college that the student is a patient could constitute a breach of confidentiality.

There is no strict necessity to seek consent from the patient if you are just commenting on whether or not you issued the certificate. But you should consider contacting the patient before replying to let him know that the college has queried the certificate, and how you intend to respond. Be aware that there is a danger of ‘tipping off’ the patient about the investigation, for example, if there is an ongoing fraud inquiry, therefore you should also take into account the views of the college.  

If you do decide to contact the patient, you can explain that you have a duty to give accurate and honest answers to questions about documents which appear to bear your name but that you do not intend to give out any confidential patient information about him. This will allow you to comply with your ethical duty to ensure that documents in your name are not misleading, while maintaining the doctor-patient relationship.  

Dr Phil Zack is a medico-legal adviser at the MDU

Readers' comments (1)

  • I concur with Dr Phil on this one. No confidentiality has been breached by responding to the college that you did not write/sign this letter.

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