Instant medical certificates, long term consequences

Procuring online doctor’s certificates for work or school has become a widespread practice. But the implications for participating doctors could be very serious.

Australia’s medical watchdog told InSight+ that doctors employed by companies advertising “online medical certificates” that are “quick and easy” may be breaching professional standards.

“Writing a medical certificate is a medical service. It requires a real-time doctor–patient consultation for the doctor to assess the patient, provide any necessary treatment and decide whether a certificate is indicated,” a spokesperson for the Australian Health Practitioner Regulation Agency (Ahpra) and the Medical Board of Australia said.

The increase in online telehealth sites prompted Ahpra to release new guidelines for telehealth last year.

Ahpra is very clear that the Medical Board of Australia code of conduct, including Telehealth guidelines, applies to all medical services.

“The Telehealth guidelines are clear: providing health care without a real-time consultation is not good practice. Issuing a medical certificate is not just an administrative task. It requires medical judgement and is providing health care,” the Ahpra spokesperson said.

Australia’s peak bodies for medical practitioners question the use of these certificates for employers, as they don’t require a proper consult and sick employees can simply stay at home.

The Royal Australian College of General Practitioners (RACGP) labelled the online practise of acquiring what they describe as an “instant” medical certificate as “farcical” and a “joke”.

“What’s the point in these medical certificates, if all you need to do is ask for one and this company is just willing to give one, what benefit is it to the employer?” RACGP Vice President Associate Professor Michael Clements said.

“If the employer is asking for confirmation that there is a medical illness, then this obviously doesn’t meet that requirement,” he said.

The President-elect of the Australian Medical Association, Dr Danielle McMullen, wants to see more workplaces allow employees to "self-certify and stay home" without certificates.

“Mild illnesses can be a big burden on the health system when people can often be trusted to know that they’re just sick and don’t want to spread it around the workplace,” she said.

“Why do we instead require a certificate written with minimal clinical input in the case of a telehealth certificate providing service?” she said.

While affordability is a major incentive for the demand of online sick certificates, Dr McMullen says many sites are ineligible for medical rebates and fail to take a whole-health history into account.

"We think that with all health concerns that need medical treatment or medication, you should have a consultation with a doctor, who will ask you about your symptoms and make sure you’re being offered the full range of medical options," she says.

Under Australian workplace laws, it’s up to employers to decide if they require a certificate for days off sick for their employees. The law also doesn’t exclude certificates acquired online, stating a medical certificate is an acceptable form of evidence for days off.

A Fair Work Ombudsman spokesperson said that under the Fair Work Act 2009, an employer can request evidence from an employee for as little as one day or less off work.

There is no strict Fair Work ruling on what type of evidence an employee needs to provide for sick leave either, except that it has to convince a reasonable person.

“The Fair Work Act doesn’t specify what evidence must be given for sick leave,” the spokesperson said.

“Medical certificates or statutory declarations are examples of acceptable forms of evidence.”

The RACGP spokesperson said these type of “pop-up” business models are becoming increasingly common.

“These services are often making use of loopholes in legislation,” RACGP’s Professor Mark Morgan said.

“To make money, they need to provide lots of items of service in the shortest timeframes,” Professor Morgan said.

Meanwhile, RACGP Vice President Associate Professor Clements said he would not be surprised if employers stop accepting certificates issued by them.

“The employers may just start saying, ‘No, we don’t accept online medical certificates’, because it’s farcical, it’s a joke,” he said.

While online medical certificate businesses are making money out of this model, it’s the certifying practitioners themselves who are potentially putting their livelihoods at risk.

“Doctors whose conduct varies significantly from codes and guidelines must be prepared to explain and justify their decisions and actions,” the Ahpra spokesperson said.

“Serious or repeated failure to meet standards may have consequences for medical registration”.

If a patient’s health deteriorates and they haven’t had a proper consultation, legal and professional repercussions could fall to the practitioner.

“The potential repercussions for practitioners are the same as for any other consultation where there has been an inadequate assessment made of a patient,” the Ahpra spokesperson said.

“Patients may pursue their legal rights and can also make a notification, which the Medical Board of Australia will consider on a case-by-case basis.”