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Practice dilemma: Fake sick note

An employer phones your practice about a suspected fake Med 3 form that states an employee should refrain from work for four weeks. What should you do?

The patient has a right to expect confidentiality from the practice. However, an employer also has an expectation that they can rely on the contents of a letter, report or certificate signed by a doctor. It can be difficult to balance these two expectations.

In the first instance, patient confidentiality needs to be preserved. There is the possibility that there has been a simple administrative error that has resulted in the apparent discrepancy. The person best placed to resolve that issue is the GP who wrote the declaration.

In order to do so it will be helpful to make a written record of employer's query, and ask for sight of the Med 3 form so that the GP who wrote it can refresh his/her memory, and check the contents of the note against the records.

Subsequently, the GP should then be in a position to say whether the note is accurate, whether he has made a mistake, or whether the note has been amended by a third party.

Ideally the GP should have patient consent to discuss matters with the employer. Where this cannot be obtained or is impracticable, remember that the purpose of the Med 3 is to convey information to the employer – it should not mislead. Although further personal or clinical details should not be disclosed, it is reasonable for the doctor to confirm the accuracy, or otherwise to someone who is going to rely on it. Bear in mind that the patient may not agree, and may seek to complain.

Dr Nick Clements is head of medical services (Leeds) at the Medical Protection Society


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