Labor MP Craig Thomson is the latest Australian worker to be stung by the outdated culture of medical certificates. Thomson fell ill last week with abdominal pain and was issued a medical certificate that would keep him from parliament this week.
The federal opposition has questioned the nature of Thomson’s illness and demanded a certificate from the hospital he attended. For most people, the implications of not having a medical certificate are much less significant than what Thomson is facing. But this case highlights the futility of how we deal with absenteeism due to illness.
I’ve been a doctor for 51 years and have been asked for a sickness certificate about twice a day during that time. Requests take two main forms:
someone has the common cold, is clearly unwell and shouldn’t be at work or in a GP’s waiting room coughing and sneezing over other patients and practice staff; or
someone has been denied payment for sick leave until they produce a doctor’s certificate. Most GPs write, “Mr Absent tells me that last month he was off work for five days because of a severe bout of hay fever.”
Sadly, I’ve never had such a worthless certificate queried. In fact, only two of the over 20,000 medical certificates I’ve written in my career have been questioned.
The first involved a train driver with a “privately acquired” disease. His line manager would not accept my statement that this man was fit to resume his occupation. The manager wanted to know the train driver’s diagnosis. I refused to comply on the grounds of medical confidentiality.
Since my patient’s employment remained in limbo, I wrote a further medical certificate stating, “Mr. Traindriver had a temporary, lower urinary track (sic) obstruction that has been cleared”. He was allowed to resume driving large locomotives.
The second query concerned a young lady who’d been involved in a minor motor accident that caused her to miss a two-hour practical class. I wrote: “Miss Uni-student told me that she had a motor vehicle accident this morning. She did not sustain any injury. I cannot believe that a university has so little trust in its students that it demands a medical certificate for an absence of only two hours.”
The young lady’s mother claimed that my medical certificate would antagonise her daughter’s lecturer and jeopardise her daughter’s academic progress. So I wrote to the dean of her faculty who replied that foreign affairs regulations demanded fee-paying students account for their absence from formal classes to ensure they were not engaged in illegal activities.
The maintenance of a civil society requires checks and balances; employers need a reliable workforce and unions need to provide workers with protection from employer exploitation. But between them, they’ve created a mindlessly wasteful system.
The union movement fought for the right of workers to a designated number of days of paid sick leave. In the 1920s, this was to protect the income and the job of a sick worker. This humane provision has become an entitlement, creating a perverse incentive for employees to take a sick day when they’re not really ill.
Employers, in turn, demand information about short absences from work that are none of their business and which no ethical doctor should provide.
These “sickies” are estimated to cost the Australian economy $3 billion a year. The main, albeit reluctant, arbiter in this balancing act between the employer and the “sick” employee, are doctors.
As a doctor, I begrudge the mutual waste of time, when a genuinely ill and long loyal patient requires me to write a sickness certificate for being absent from work for more than two consecutive days.
Last year, I saw a policeman with a severe case of influenza. He’s trusted to carry a baton, a taser and a pistol, and to drive a high-powered pursuit car. He’s also trusted to tell the truth when giving evidence in court. But he needed a sickness certificate because he was not trusted to say he was unwell.
Consultations for the sole purpose of getting a sickness certificate also use up appointment slots, to the detriment of patients who actually need access to the medical care that general practitioners have spent ten years learning to provide.
Writing sickness certificates where there’s no present or past objective evidence of illness is an administrative, not a medical, task. And by its very nature, it’s one that can compromise a GP’s integrity. Certifying short periods of time off work is not the business of doctors. It’s the business of employers and employees, and should be worked out between them. Doctors are sick to death of being asked for sickness certificates.
Employers’ requirement for sickness certificates to cover an employee’s time away from work due to the flu is mindless and aimed at diffusing responsibility from an individual employee and their manager onto a doctor. Equally inane are the certificates of wellness demanded for joining a gymnasium or participating in a fun run.
Medicare is vigilant about doctors whom they suspect of rorting their system. But sickness certificates don’t fall under their definition of a rort. If any other government-supported organisation annually wasted $60 million of taxpayers’ money, it’s likely that this would be noticed, investigated and put to right.
But, in Australia, all we’re doing is marveling at the posturing of the Pharmaceutical Society of Australia and the Australian Medical Association about who should be allowed to issue sickness certificates.
Sickness leave is an expensive economic problem for all developed countries. Its solution has engaged the attention of industrial psychologists and labour market researchers. But, neither the Industrial Relations Commission, labour market experts, nor health service employers, have given any thought to the place and problems of doctors in certifying sickness leave.
So, are there any solutions to this mindless ritual of “get a note from your doctor”? Well, yes there are. For starters, stop arguing about who should be allowed to write sickness certificates for short, self-limiting episodes of illness, and start discussing whether these certificates need to be written at all.
Then, we need a debate about the amount of surveillance the Australian community is prepared to accept in its pursuit of accountability. And a change to the Scandinavian model where employees can have seven consecutive days of sick leave without having to provide a doctor’s certificate would immediately reduce the demand for medical certificates.
Absenteeism from work is a serious and complex area. But when it’s due to minor, self-limiting illnesses or “sickies”, GPs don’t have to, or want to, be involved. We have far better and more important things to do than be a reluctant clerical cog in a pseudo-system that pretends to account for the absence of people from their work.
A short period of absenteeism, for whatever reason, is an issue between an employer and an employee and possibly, their unions. If the employer wishes to involve a third party, the onus of action and expense should be on that employer and not on doctors and Medicare.
Acknowledgements Drs Mark Diamond; John Kramer; Tim Leeuwenburg; Matthew McLean; Richard Nowotny; Zelko Pecotich and Mr James Hamilton, resident philosopher of Home James Taxis, Hobart, for providing or refining some of the ideas in this paper.