Principle of Professional Ethics_ Red Book

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					Principle of Professional Ethics,
Red Book

         Clarence Choi
       KCC FM C1 Trainee
          24-10-2007
Part III
• Professional Misconduct
  – A. Professional Responsibilities to Patients
     • 3. Untrue or misleading certificates and other
       professional documents
Statistics on Disciplinary Cases Handled by the
Medical Council 2003

• Complaints received by the Medical Council
   – Issuing misleading, false medical certificates –
     24/350 ~ 6.8%
Preliminary Investigation Committee (PIC) - 2004


• Total cases considered by the PIC – 112
  – Issuing untrue or misleading medical
    certificates – 6 ~ 5.4%
• Total cases referred by the PIC to Council
  for inquiries – 25
  – Issuing untrue or misleading medical
    certificates – 1 ~ 4%
Preliminary Investigation Committee (PIC) - 2005


• Total cases considered by the PIC – 123
  – Issuing untrue or misleading medical
    certificates – 8 ~ 6.5%
• Total cases referred by the PIC to Council
  for inquiries – 31
  – Issuing untrue or misleading medical
    certificates – 3 ~ 9.7%
Untrue or misleading certificates and other professional documents



• Medical practitioners are required to issue
  reports and certificates for a variety of
  purposes (e.g. insurance claim forms,
  receipts, medical reports, international
  vaccination certificates, incapacity to work
  through illness or injury certificates etc.) on
  the assumption that the truth of the
  certificates can be accepted without question
Untrue or misleading certificates and other professional documents



• In some cases the certificates are required to
  include a statement that a patient has been
  examined on a particular date
• Medical practitioners are expected to
  exercise care in issuing certificates and
  kindred documents, and should not include
  in them statements which the medical
  practitioner has not taken appropriate steps
  to verify
Untrue or misleading certificates and other professional documents



• Any medical practitioner who in his
  professional capacity gives any certificate or
  similar document containing statements
  which are untrue, misleading or otherwise
  improper renders himself liable to
  disciplinary proceedings
• In particular, medical practitioners are
  warned that the signing of blank certificates
  is prohibited by the Council
Untrue or misleading certificates and other professional documents



• Doctors must not issue more than one original
  receipt in respect of the same payment
• Copy receipts must be clearly stated to be copies
  or duplicates
• If it is necessary to issue separate receipts for
  fractions of the payment for a single item of
  service, it should be clearly stated in each
  receipt the amount of the full payment and that
  the receipt is in respect of the part payment
  only
Single item of service
• Examples of acceptable items
  – Consultation
  – Medication
  – Procedures
Case 1
• My patient Mr. A has accident insurance
  with two insurance companies, and wants to
  make claims for medical expenses and
  compensations from both companies. He
  asked me to divide my fees into 2 equal parts
  and issue one receipt for each of the 2
  insurance companies
• Is this alright?
Case 1
• Advised not to divide your fees artificially
• Should issue only one original receipt for
  each service rendered on any one day
• May issue separate receipts for consultation,
  medications and laboratory/X-ray charges,
  with these items clearly printed against the
  amount received for each item
Case 1
• May also issue a 2nd receipt for a medical
  report to the 2nd insurance company if a 2nd
  receipt is required
• If the patient loses the original receipt, you
  may issue a copy of the original receipt with
  the word “copy” clearly written on it
Case 2
• My patient Mr. „s company will only accept
  medical bills for no more than 2 days‟
  medications. He asks me to write a separate
  receipt for the medication fees he pays
• Is this allowed?
Case 2
• May issue separate receipts for consultations
  and medications with these items clearly printed
  against the amount received for each item
• May also issue a receipt for your consultation
  plus 2 days‟ medications and a separate receipt
  for the extra medications you prescribe with the
  word “extra medications” printed against the
  extra amount the patient has to pay out of his
  pockets
• May give a prescription for the extra
  medications and ask the patient to have it filled
  in a drug store
Case 3
• Can I backdate a sick leave certificate on the
  day I did not see the patient?
Case 3
• Under normal circumstances, doctors should
  avoid backdating sick leave certificates to
  patients
• Exception can be made if the patient has
  been under his continuous care and he is
  satisfied that the patient‟s history and
  physical findings did suggest that the patient
  must have been unable to work on or before
  the commencement date of the sick leave
Case 3
• Sometimes may be acceptable even if the
  doctor sees the patient for the 1st time e.g. if
  the patient is deeply jaundiced by the time he
  consults the doctor
• Note that the doctor might stand being
  challenged
• Hence extra care should be exercised and
  detailed medical records should be kept
Case 3
• The date of issue of the certificate should be
  the day when the doctor saw the patient and
  not the day of commencement of the sick
  leave
Issuing Sick Leave Certificates
• The Working Group to Study Abuse of Sick
  Leave Certificate by Employees under the
  Employment Ordinance
• Medical certificate recommending sick leave
  should include key information such as the
  name of the patient, the medical condition,
  the duration of sick leave recommended
  (with specific dates), and the date of issue of
  the medical certificates
Issuing of Sick Leave Certificates
• Information entered into the medical
  certificates should be legible and clear and
  abbreviation to medical terms should be
  avoided as far as possible
• Medical practitioners should maintain an
  efficient system of record keeping of medical
  certificate that have been issued in order to
  facilitate clarification/verification of such
  information by patients and their employers
Case 4
• Patient D has requested me to issue two
  “original” sick leave certificates for one
  consultation. One is for submission to his
  employer and the other is to the insurance
  company for claim reimbursement
• Am I allowed to do that?
Case 4
• It should be permissible to issue two
  “original” sick leave certificates and dated
  the same day to patients who have genuine
  reasons such as this one
• Any other situations?
Case 4
• Patients who have 2 jobs!
Case 5
• A patient has requested me not to write
  down the diagnosis in the sick leave
  certificate issued by me
• What should I do?
Case 5
• As much as possible, the patient‟s wish should
  be respected
• However the medical condition should be
  written down
• May use general terms such as “urological
  condition” and “orthopaedic condition” instead
  of “gonorrhoea” and “Charcot‟s joint”
• These general terms adequately explain the
  medical condition for the purpose of sick leave
  certificates and all information given should be
  factual
Case 6
• Can a doctor issue sick leave certificates for
  some days in the near future?
Case 6
• Unusual
• Certain circumstances
  – Scheduled elective admissions/operations in the
    future
Case 7
• I am employing a locum in my clinic. Can he
  use my letterhead and stamp my name on the
  sick leave certificates he is issuing to patients?
Case 7
• Any registered medical practitioner may
  issue sick leave certificates to a patient after
  consultation
• Your locum may use your letterhead to issue
  sick leave certificates, but he should sign and
  stamp his own name on it
Fraudulent Sick Leave
Certificates
• Anyone producing a fraudulent sick leave
  certificate has committed a criminal offence
Case 8
• I received an enquiry from a school on a sick
  leave certificate of a student, issued under
  my name. I have checked that this student
  was not my patient and the certificate was
  fraudulent
• What actions should I take?
Case 8
• Legal matter
• May be called to appear in court as a witness
  if the school has already reported to the
  police
• Should find out where the student got the
  fraudulent certificate form e.g. from another
  patient or from your staff
Case 9
• The employer of one of my patients has sent
  me a copy of my sick leave certificate for
  confirmation. The number of days of sick
  leave was changed from 1 to 5.
• What can I do without the patient‟s consent?
Case 9
• 1st confirm that the person making the
  enquiry is the patient‟s employer
• Without the patient‟s consent, you can still
  confirm that according to your record, the
  number of days of sick leave you had put
  down was one
Conclusion
• A sound practice
  – Good documentation
  – Trustworthy doctor-patient relationship
References
• Professional Code and Conduct, for the guidance of
  registered medical practitioners, Medical Council
  of Hong Kong, 2000
• Questions frequently asked by members and
  answered by duty council members, a handy
  reference, The Hong Kong Medical Association,
  June 2004
• HKMA news, The Hong Kong Medical Association,
  July; September, October 2007
• The Medical Council of Hong Kong, Annual
  Report 2003-2005