GPs are expected to assume many different roles in their daily working lives. But like many other aspects of their responsibilities, this is expected to be simultaneous at times.
Consider how many hats you need to wear when you are seeing someone whose only living relative has just passed away and the patient herself has multiple chronic problems. I can think of a counsellor’s, a psychiatrist’s, a social worker’s and last but not least that of a doctor’s.
Or there’s the scenario where you are supposed to be a patient advocate, when you have to certify someone for eligibility for unemployment, sickness, pension and/or similar benefits. At the same time of course you are expected to be a ‘gate keeper’. Signing off for an elderly patient’s driver’s license is yet another hat that must be
worn.
The problem is, a typical patient seeking a social security or worker’s compensation entitlement sees a knee pain, for instance, as enough of a reason to be certified unfit for work for as long as the problem may persist.
Almost every other chronic condition, be it depression, asthma, diabetes and so on, is also seen by many as a condition that should excuse them from even looking for a job. Depending on their attitude, motivations and other agenda, this expectation may be for benefits for the short (sick notes) or long term (obtaining pensioner
status).
Given that as a doctor you cannot always be confident about the justification for a medical certificate, even for apparently straightforward complaints such as a common cold, the more elaborate scenarios present even greater issues for GPs.
We can delay certifying them, by ordering investigations and referrals and basically passing the buck. However, if you are sympathetic to patients because they may have been seeing you long term or you are too busy to consider the long-term consequences of your actions, a large number of common problems encountered in general practice can be certifiable for all manner of benefits.
What the wider consequences of being on either side of this arbitrary line in the sand entails is beyond the call of this column.
However, suffice to say that on many occasions you are dammed if you do and dammed if you don’t. This clear of conflict of interest is a matter of pure mathematics and business viability issues on the one hand, and ethics and morality on the other.
As things stand, there is no escaping from it easily. However, a debate is in order soon, given the government appears to be intent on tightening the social security purse strings.
The best compromise may well be an independently appointed doctor who receives a summary or full copy of the medical records with a confidential recommendation from the GP.
The final arbiter should be or appear to be the independent doctor, so that the GP is not the proverbial meat in the sandwich.
22nd Oct 2014; Medical Observer; Dr Tony Marshal; GP, Frankston, Victoria
