Certificates, our constant companions for years through all the bureaucratic practices we are obliged to perform with regard to many daily tasks and duties, derive from the Latin certum facere.

Everything must be certified, from birth to death: school, work, residence, marriage, family status and so on. Besides the certifications doctors must issue know no limits, ranging from patient history certificates for driving licences and gun licences to those of pregnancy, childbirth, school and those that confirm physical fitness to perform certain activities.

Then again many types of certificates are required concerning the ability to work. They range from suitability to perform a task to illness: the disease’s onset, its protraction and then return to work. And the barbs of the media that are ready to accuse doctors of complaisant certifications concerning the working world’s many distortions are targeted at this last category of certificates. Recent unrest among in-flight personnel has repeatedly shown how small groups of people can stop a nation with just a category-strike.
This unrest opened another wound in the system with concurrent requests made to doctors by a few hundreds of well-organized employees for a day’s rest, pleading the most diverse physical ailments. It was a form of unrest that, among other things, has already become the object of disciplinary measures and investigations conducted by the magistracy and focused on Alitalia in-flight personnel and the doctors who issued the medical certificates.
The incident was clearly planned and implemented thanks to the relatively low number of requesting parties (they were mostly in-flight hostesses) who, mixing among the great number of patients who daily crowd medical practices, were easily able to convince the doctor that they were suffering from one of those trivial transient ailments that affect many patients, especially women, forcing them to brief periods of rest. No doubt many doctors, taken up in the vortex of increasing paper work, do not give certifications their due importance when they fill them out. One of the most frequent disciplinary measures taken by Medical Association Committees particularly concern certifications.
A frequent case faced by disciplinary measures is the certificate’s date of issue that must always and however correspond to the exact moment the doctor sees the patient. At times a doctor does not see the patient the day the disease first appears and certifies the disease in good faith by writing the date of onset and not the day he examined the patient who, incidentally, was seen busy performing activities of quite another nature that very day.
Another recurrent disciplinary measure taken by Medical Association Committees concerns the patient’s absence when a certificate is issued. In this case too the doctor certifies in good faith, without examining the patient and without even having seen him, the disease of a son, husband, father or wife on the basis of a relation’s statement that the patient had felt faint and was in bed, while he was really somewhere else. Unfortunately the enormous volume of requests doctors have to daily face has, in practice, made a trivial matter of drafting a document that instead personally involves the doctor’s professional, civil and penal responsibility. When he fills out the certificate, he also bears witness that he saw the patient that very day and at that time with all the possible consequences of a false declaration.
This issue was recently discussed at a round table conference organized at the Snami Congress held in Trieste with the participation of magistrates, lawyers expert in labour suits, the Trieste State Audit Court’s solicitor, the Director of the Institute of Forensic Medicine of Trieste and many doctors who debated on problems concerning certification and medical prescriptions. The discussion revealed the absolute confusion concerning laws and sentences issued by Regional Administrative Tribunals, Civil and Penal Courts, the State Audit Court and various departments of the Court of Cassation, extensively proving that it is not easy to understand how the law can be enforced without risking a law suit in Italy, especially concerning NHS pharmaceutical prescriptions. Yet it is a fact that certifications must always be filled out and issued responsibly because they are very often bound to the form, as they cannot go into the heart of the matter.
Hence the person in trouble is the doctor who trusted his patient and not the cheat who tricked his family doctor causing him serious trouble. Nevertheless one may naturally try to understand why similar distortions take place, the fact remains that reciprocal trust, which is the basis of the doctor – patient relationship, obliges the doctor, who is called to treat an illness and not to ascertain its truthfulness, as happens with the fiscal doctor, to accept what the patient states to be true. Hence the need, repeatedly presented to the legislative organs by doctors of the Snami, to accept the sick worker’s self-certification for short periods that can range from one to three days. At a time of extensive law-making on citizens’ right to self-certification and privacy, the word of an employee, who personally takes on the responsibility of declaring he is suffering from a transient ailment that the family doctor may find hard to ascertain, must be considered more than adequate, rather than charge the doctor with a duty he should instead perform fully in case of a real illness.

Translated by interpres sas