Intended for healthcare professionals


From sick notes to fit notes

BMJ 2009; 339 doi: (Published 10 August 2009) Cite this as: BMJ 2009;339:b3114
  1. Jos Verbeek, occupational physician1,
  2. Ira Madan, consultant occupational physician2
  1. 1Coronel Institute of Occupational Health, Academic Medical Centre, Amsterdam, 1105 AZ, Netherlands
  2. 2Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT
  1. Jos.Verbeek{at}

    Doctors need better support in dealing with work related medical problems

    Dame Carol Black’s report Working for a Healthier Tomorrow strongly advocates changes in the arrangements for sickness certification to promote better health of the working age population in the United Kingdom.1 The report states that current social security systems encourage people to stay off work until they are fully medically fit to return to their job. This policy increases the risk of long term disability and subsequent loss of employment.

    General practitioners are usually the first healthcare professionals that employees encounter when they are off sick from work. After seven days of absence from work because of illness, employers can request a sick note from the employee, so they can claim statutory sick pay. Employees will usually seek advice from their general practitioner regarding their fitness to return to work. Herein lies the problem. General practitioners feel that they are the patients’ advocates and thus have to follow their patients’ wishes. Few general practitioners think that …

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