Rapid Responses to:

LETTERS: Paul V Mackey Sickness certification system in the United Kingdom: Maybe charging for certificates clarifies matters BMJ 2004; 328: 461-a [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Self-certification

Francesco Carelli   (23 February 2004)

Self-certification 23 February 2004
Francesco Carelli, EURACT Council ,National Representative - RCGP 43017 - GMC 4256757 - Italian College of G P 20123 - Milan - Italy Send response to journal: Re: Self-certification	Sick certificates by GPs stimulate a lot of concerns in Italy. Sometimes, they are used against GPs like in the last strike by Alitalia workers. Sick certificates challenge the relationship between patient and doctor because always it's a third party that demands them and not the patient and we are like " condiscendent policemen " just because the patient demands it. Frequently, patients use this system deciding by themselves their " ghost disease " and the time necessary for recovering. As in the article by Paul V. Mackey, any professional relationship that is based on fear for loosing the patient or just "giving them what they demand" is dysfunctional and needs to be terminated anyway. Probably the solution could not be with not free certificates as the ones patients voluntary ask for insurance. Sickness certificates had to be self-certificated, at least for few days, under patients' responsability and a third party had to control them. This for the best in the GP - patient relationship. Competing interests: None declared