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EDITOR'S CHOICE: Richard Smith Medicine's complexity: exhausting or inspiring? BMJ 2004; 328: 0-f [Full text]

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Medical Certificates: Challenging but Essential Part of Job

graeme mackenzie   (11 January 2004)

Changing times

Debasish Debnath   (21 January 2004)

Medical Certificates: Challenging but Essential Part of Job 11 January 2004
graeme mackenzie, gp Whitehaven CA28 7RG Send response to journal: Re: Medical Certificates: Challenging but Essential Part of Job	There is actually no-one in a better position to issue a sickness certificate than the GP. He has the information at hand and sometimes good knowledge of the patient. Independent examination would be an unmanagable system with constant requests for the GPs opinion and records anyway. My role in sickness certification has made me realise that GPs are not patient advocates but an essential part of society's machine. People need somewhere to go when they are ill or believe themselves to be ill or even if they are swinging the lead. As GPs we are an essential a part of the system which tries to ensure people are using the country's resources appropriately. The government drops our gatekeeping role at their peril. The ability to negotiate a sick note and know how to balance what is best for the patient (i.e perhaps not adopting the sick role)and what is best for the system, is a huge responsibility and intellectualy quite challenging if you think the thing through on a patient and societal level. A lack of ability to confront patients is actually a deficiency in GP skills. The epidemic of illness behaviour and sick role adoption is partly our fault. Competing interests: None declared
Changing times 21 January 2004
Debasish Debnath, Clinical Research Fellow Department of Surgery, Polwarth Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD Send response to journal: Re: Changing times	It would be difficult to find any reason that would condone the act of ‘public demonstration’ of medical examination of Saddam Hussein.[1,2] But what choice did the lone medic really have in those circumstances? Perhaps none. Looking at other way round, do perpetrators of terrorism/violence spare doctors/allied personnel? I think not. The evidence is there in Israel-Palestinian conflict. Hippocrates had formulated his oaths long before September the 11th. It time that we start seeing matters in the current context. Perhaps what we need is a modified Hippocrates oath. Question is who is going to write it? Will it be independent and acceptable to all? Unlikely so, given the conflicts of interests that affect us all in today’s world. Till we reach a consensus, let us not duel too much about the morality of medical practice, particularly in areas of conflict. [1] Smith R. Medicine’s complexity: exhausting or inspiring? BMJ 2004; 328: 10th January (Editorial). [2] Jabbour S. Fall of a dictator, failure of ethics. BMJ 2004; 328:115. Competing interests: None declared