Dottor Pavone, a contributor and friend, responds to the issues raised by our editorial for the fourth number, regarding the responsibilities of general practitioners in issuing certificates justifying absence from work for health reasons, with the proposal emerging during the conference organised by Snami on this very subject.
Whilst respecting Dottor Pavone's ideas, we are a bit puzzled about the solution suggested, which in the case in point provides for self-certification covering the first days of a disease.
In our society, which tends to relieve all institutional roles of responsibilities, by entrusting the conscience of individual people with the authority to legitimate themselves, medical self-certification is the latest! In this way we would take away from the doctor the hot potato involved by acting as an intermediary between the employee, who is sick, but not that much (only for the first few days?) and the employer, who is never quite sure how to credit the employee's absence (Alitalia has provided tangible evidence as to how such an absence may be caused by reasons which are quite different from those involved by health problems!)
However, if we carefully analyse the problem, we realise that at the root of this solution is a real abdication, on the part of the doctor, with regards to his/her specific professional competence: the diagnosis regarding the patient's health. Is a private citizen capable of telling the difference between the light symptoms that may be covered by self-certification and those which, on the other hand, require medical action? And … on what knowledge can this decision be based? The knowledge provided by TV adverts on medicines? Or that provided by popular pseudo-scientific magazines? And who will be liable for any mistakes a citizen may make in this regard? Medical practitioners, who are already quite frustrated as far as their public image is concerned, by a range of rights and duties that are not clearly expressed, would in this way lose a further and very specific role: that of being our point of reference for health problems through a diagnosis certificate.
And a doctor's responsibilities also include not giving in to the repeated requests of his patients, should they require a justification when they simply wish to 'skip' work! The rule codified by certification is a way of holding within the tracks of responsibility the behaviour of both patients and doctors. It is up to those who have the proper tools to check the honesty of their members to supervise them and make sure they carry out their task as "certifiers" in a serious and honest manner, and make sure that any incorrect action does not take place again! Lately we have been noticing "in the field" how the "points" system has a deterrent power that is yielding fruit with drivers much more than the many "promotional campaigns" dealing with proper compliance with the rules of the road! And what if… like in the case of school reports and on the roads with the points system, we also applied to certifications the logic of credit and demerit points? How many people would dare ask their doctor to certify their illness for more days than necessary, knowing that they may lose the right to healthcare assistance after a certain number of … infringements? How many doctors would prove more responsible and attentive in monitoring the actual gravity of their patients' illnesses if they knew they could in turn be penalised? A society that gives and takes away points isn't that nice... is it? There are so many considerations that could be made about the times we are going through today, so troubled and complex!
Yet this is quite another story… let's talk about it! Translated by interpres sas