Ten practical tips for doctors issuing fitness certificates to patients

1. Avoid unnecessary abbreviations and medical jargon in the certificate. 

2. The certificate should be issued based on a face-to-face consultation.  

3. Remember the test for negligence:  a claimant must show that you have deviated from a general and approved practice.  Would your actions receive the support of your peers or would they follow a different course of action? 
4. Include the following disclaimers on stationary prepared specifically for issuing the certificate: 

•  That the fitness certificate is being addressed only to the patient, to support their rehabilitation to work
• That the fitness certificate is not addressed to nor to be relied on by any third parties nor to be used for any medico-legal purpose without your prior, written authority
• That the assessment of the fitness of the patient is based on the information provided by the patient, which the doctor is taking at face value and honestly believes
• That the doctor has no specialist knowledge of the patient’s workplace and no particular knowledge of what the job entails
• That the doctor has not considered whether any possible changes to the patient’s workplace or job might be appropriate.

 5.  Where an employer contacts the medical practitioner to verify a fitness certificate, the medical practitioner should verify the employer’s identity and confirm the veracity of the certificate.  The doctor should not provide other information about the patient without the patient’s express consent.

 6.  Doctors should avoid issuing a fitness certificate to anyone with whom they have a close personal relationship. 

 7.  Keep detailed, contemporaneous notes of all interactions with the patient. Include detailed supporting evidence to justify the issuing of the certificate.  If it is not recorded adequately or at all in your notes, then it didn’t happen.

 8.  Caution should always be exercised when expressing an opinion in the context of adversarial employment situations.  Document what you know, not what you think.  Make sure to avoid imprecise wording; do not display bias; use neutral language, avoiding any hint of favouritism; and avoid broad characterizations.

 9.  Never use your notes to gratify your anger with a patient. An angry, impulsive communication by a doctor that injures a person’s reputation could lead to a defamation claim that will be difficult to defend.  

10.  Never retrospectively alter your notes.  If you do have to amend your notes at a later date, include your initials the date and time of the amendment and the reason for the edit, to make it clear that the amendment is bona fide and not for any sinister purpose.