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The issue of fraudulent sick certificates is becoming an increasing concern for GPs across Ireland. With the pressures of work and personal commitments, some patients may seek to obtain sick certificates days or weeks after they have been sick, without contacting the GP at the relevant time. They may even forge them outright. This not only undermines the integrity of the healthcare profession but also places GPs in difficult ethical and legal situations. This article explores the issue, highlighting the professional obligations of GPs and outlining the appropriate course of action when made aware that a sick note may be false.
The Medical Protection telephone adviser provided clear advice on how to handle the situation while maintaining professional integrity and patient confidentiality. The key advice included:
Do not respond to the employer’s email without the patient’s consent Patient confidentiality must be upheld, even in the face of a potential forgery, as outlined in the Medical Council’s Guide to Professional Conduct and Ethics. The guide states: 'Confidentiality is central to the trust between you and your patients, and is a core element of the doctor/patient relationship.' It further advises that doctors must protect patient privacy and only disclose information with the patient’s consent or if there is a legal or public interest justification for doing so.1
Contact the patient and discuss the matter in a non-accusatory manner The patient should be given an opportunity to explain the situation. If the patient admits to forging the certificate: • The GP must assess whether the therapeutic relationship has been irreparably damaged. This includes considerations such as the nature of the issue, the patient's history with the practice, and the potential impact on other patients and staff.2• Consider whether a formal warning is warranted in line with your practice policy, ensuring that any actions taken are consistent with the policy provisions and ethical guidelines. If the patient denies forging the certificate: • Seek the patient’s consent to inform the employer that the sick note was not issued by the practice. • If the patient refuses consent, the GP cannot disclose any information to the employer. The employer may then draw their own conclusions from the GP’s silence. Like above, it is important in this scenario to consider whether the therapeutic relationship has broken down. However, you must ensure that you bear in mind the fact that the patient has denied forging the certificate and take care not to come across as accusatory.
While it is important to acknowledge that advances in technology, especially AI, have made it increasingly difficult for employers to be certain that a sick note isn't forged, GPs can take several proactive measures to minimise the impact when such incidents arise.
Record-keeping: Detailed and accurate record-keeping is critical. Every consultation should be properly documented, including notes on any refusals to issue sick notes. By maintaining comprehensive records of the reasons behind clinical decisions, GPs can ensure they have a transparent account of their actions. In the event that a sick note is questioned or suspected of being fraudulent, having clear records can protect the GP from potential legal or ethical issues.
Security features: Explore whether there is an option within your practice software system to create tamper-proof templates. Alternatively, by adopting secure, verifiable formats such as digital signatures or encrypted electronic documents, the integrity of the sick note can be safeguarded against falsification. While this doesn't eliminate the risk, it could make the process more robust and easier to verify, should any questions arise regarding the validity of the sick certificate.
Awareness of technological advances: Despite all preventative measures, it’s important to acknowledge that we cannot be entirely certain that a sick note won’t be forged, especially in light of the rapid advancements in AI and other technologies. While it is increasingly difficult to detect fakes with complete certainty, GPs should remain vigilant and mindful that these technological developments may enable even more sophisticated forms of forgery.
Addressing suspected forgery: If a forged sick note is brought to a GP's attention, the most appropriate course of action is to follow the steps outlined above and act in line with your professional and ethical obligations. If the GP is unsure about the authenticity of a sick note, you should contact Medical Protection for expert guidance. It is critical to avoid making assumptions, as some cases of suspected forgery may require more investigation before drawing conclusions.
The forging of sick certificates can harm a doctor-patient relationship built on trust and place GPs in challenging professional situations. By adhering to the relevant ethical guidelines set out in the Medical Council guide, maintaining meticulous records, and seeking expert medico-legal advice from Medical Protection when needed, GPs can navigate these tricky situations while upholding patient confidentiality and professional integrity.
