Another ethical muddle for GMCBMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39542.452662.3A (Published 10 April 2008) Cite this as: BMJ 2008;336:788
I note that it is now acceptable for a highly respected senior occupational physician to use the phrase “unaudited farce” in public and in the BMJ in relation to sick notes.1 A major part of the workload of many occupational physicians entails sickness absence, and much of this entails disagreeing with the advice given by general practitioners via sick notes. In most areas of medicine, specialist doctors guide and advise generalists. To employ one doctor just to disagree with another is an unusual concept in health care.
The reason for this is said to be ethics. GPs are ethically obliged to be the patient’s advocate, so when patients say they do not feel well enough to work, the GP is expected to support them. A fine principle perhaps, but clearly much abused. GPs say that advising on fitness to work is an area they are untrained for. Often, however, the issue is not a challenging medical decision; the patient has long since recovered (if there ever was any disease process), and they now have nothing medically important wrong with them. The argument therefore hinges on “ethics” and the distinction between giving patients what they want, or giving them what they and society need. For ethics to create such a conflict at a suggested cost to society of several billion pounds a year suggests a profound ethical muddle.
As the General Medical Council holds the key responsibility for medical ethics in the United Kingdom, this suggests that it holds a trump card for the solution to a substantial percentage of sickness absence in the country. This was not made clear in the Black report,2 but it is an area worth exploring further.
Competing interests: None declared.