Are sickness certificates doing our patients harm?

Abstract

It could be said that sickness certification is in crisis in Australia. In 2006, legislation was passed to grant 10 new categories of non-medical registered health professionals the authority to issue sickness certificates. This action was justified on the basis that, it would relieve medical practitioners of the 'unreasonable burden' of writing sickness certificates for short term work absences. Associated media reports indicated that in general, the medical profession was opposed to this move. However, while apparently unanimous in wanting to retain an exclusive right to the certification commission, general practitioners clearly had divergent views about why this should be the case. Some GPs considered the issuing of a sickness certificate as integral to the medical management of illness; others described it as an important administrative service to the business community. None, however, expressed a view as extreme as that of Professor Gordon Waddell of the Centre for Psychosocial and Disability Research at the University of Cardiff, Wales. Addressing a 2008 British Medical Association conference, Waddell told delegates that a 'sickness certificate is one of the most powerful, potentially dangerous treatments in a GP’s armamentarium'. He supported this view by citing a body of research demonstrating the detrimental effects on health and well-being which can follow certified work absence. As various Australian non-medical registered health professionals prepare to become more involved in the issuing of sickness certificates, it is timely to review the purpose and impact of sickness certification. In particular, it is important for GPs to become aware of their key role in managing the problems associated with certification, which stem from present day beliefs about work and health.