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GPs 'should be cautious when declaring patients fit to run marathons'

GPs should take caution when asked by patients to sign forms declaring them fit to run marathons, medico-legal advisers have said.

GP indemnity provider Medical Protection said the advice comes as GPs are faced with a growing number of fitness-to-participate requests, also including for events such as 'fat camps in the desert, mock hostage situations, or events where a patient must undergo psychological torture'.

But it said GPs need to ensure they have sufficient knowledge before signing such forms, and may only wish to sign with a qualifying statement.

Medical Protection senior medico-legal adviser Dr Pallavi Bradshaw pointed out that ‘GPs must be confident that they have sufficient knowledge about the patient and the nature of the event before deciding whether they can assist’.

She said: ’GP’s may not always have the required expertise to deem the patient fit to take part without risk, and will understandably be worried about the implications of signing such a form.

’GMC guidance requires a doctor to do their best to ensure reports they write are not misleading, and says they should not undertake assessments beyond their area of clinical competence.

But she said there were 'some options where doctors can assist within the limits of their competence'.

She said: 'Depending on the wording of any declaration, signing the form with a qualifying statement may be appropriate.

’The GP would consider the information they have on the patient’s current and past medical history, which may be relevant to the event, and state that there are no known health conditions which render the patient unfit to participate.’

But she added that ’where a patient’s medical history is not straightforward or they are under the care of a specialist, the GP may wish to obtain advice first or refer the patient to a doctor with expertise in sports medicine’.

Medical Protection said this comes as a record number of people are signed up to next week’s London Marathon, over half of which are first-time marathon runners.

 

Readers' comments (10)

  • Cobblers

    "Can you just sign this 'fit to..' doc?" should be right up there in red capitals in the trainee handbook. DO NOT DO!

    Not just marathons, parachute jumps, Fit to Fly, Diving, even holidays, anything where it is outside your area of expertise.

    I stood in a surgery queue the other day and listened as the receptionist told this older chap who was audibly wheezing that the GP would sign his diving form for a risible fee, £10 if I recall.

    I happen to know that said GP might remember Boyle's law from his Physics A level but DCS (Decompression Sickness) would be a foreign land and as for Pulmonary Barotrauma, Nada!

    I just hoped that he didn't belong to the MPS as my subs are going up and up!

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  • Not GMS so not my concern. I don't do any of these forms.

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  • Speechless again at the fluffy, woolly nonsense from my own defence organisation ........referral to a doctor with expertise in sports medicine.......... This should NOT be done on the NHS. There are limited resources and wasting money in this way would be absolutely scandalous. By being asked to complete forms like these we are effectively being asked to take responsibility for anything untoward that happens to a patient during the activity in question, and we should simply be able to refuse to be part of this. As far as I am concerned the GMC and defence organisations should not be encouraging GPs to have any input at all and should be supporting GPs who just say No!

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  • I had a neighbour ask me to sign his marathon form. I said I would only sign it if I could examine him. I could hear the characteristic murmur of aortic stenosis so I refused, after explaining why. He got his own GP to sign his form, completed his marathon, and the next year had his aortic valve replaced. You should never 'just sign the form'.

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  • The London marathon never asks entrants to have a form signed by a doctor. Paris yes, but thats French box ticking

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  • *

    If you're being asked to sign a form laying your ass on the line for the sake of someone you've never met who's running an event/business/activity, effectively saying 'feel free to sue me if anything unpleasant and medial goes down' then I suggest you either charge an appropriate fee or tell them to get some other sucker to indemnify their life choices.

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  • The companies that take money for such sports/events etc should remain responsible and thoroughly advise people of the risks and contraindications for such events. These types of forms seem to stop people thinking. I had to say no to an 80 year old who had signed up for a parachute jump, collected several thousand pounds but had clear contraindications to the jump. It was heartbreaking telling him that he cannot do it and would most likely need to return all the sponsorship money.

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  • I very rarely actually say anyone is 'fit' for anything, instead stating (where appropriate) that on the basis of the medical records and without specific examination for the purpose, there would not appear to be any obvious contraindication to Mr Bloggs swimming the Atlantic, or whatever the event may be.
    Have always presumed that would be medico-legally safer but there is the concern that an individual participant could still think that they were being certified as 'fit', as requested by the organisers, with the bereaved family taking legal action on the basis that the fitness certification was misleading.
    Saying no to these requests is the better option except for our relationship with patients. If all GPs were formally advised by the defence organisations to never provide such information then the vast majority of the requests from events organisers would rapidly cease.

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  • Being a runner myself I find the request fair. If there are no medical issues specially in older patients, state that there are no medical contraindications to training to take part in marathon and also instruct patient to seek advice if develops any new symptoms. I generally pay attention to risk factors for heart disease in assessing such patients. There are running clubs one can join and also read articles on how to prepare for long distance running.

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  • Amazing that supposedly intelligent people are daft enough to sign these forms.

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