Last issue’s letter about doctors’ sick notes generated a huge response from
readers.  The general consensus is that
GPs are ignoring the consequences of their actions on UK business

Stress is the new bad back

How I agree with Paul Robertson-Marriott (Letters, 5 August). He quite
rightly calls into question the accuracy of doctors’ reports.

I would go further and question the competence and, more importantly, the
professional ethics of the majority of doctors, who seem quite prepared to
write up a sick note saying whatever an employee wishes.

I represent a large number of employers, both large and small, and the
latest scourge afflicting them all is the ‘tame doctor’.

It seems these doctors are happy to issue sick notes for far-reaching and
inaccurate diagnoses such as ‘work-related stress’ and ‘nervous disability’
(both actual examples from my case file).

Aside from the fact that stress and nervous disability are not clinical
conditions and cannot therefore be legitimate diagnoses, is any GP is in a
position to say the stress or disability is work-related?

Are we to believe that on the basis of the average 10-minute consultation, a
GP is able to deduce that an employee is suffering from stress and,
furthermore, that the stress, if it even exists, is caused by work? No, they
just make the diagnosis the patient wants.

Stress is the new bad back. The difference is the vast cost to employers of
the claims resulting from the cavalier attitude of doctors to their own

Even the Health and Safety Executive (HSE) seems to have been taken in by
this ‘epidemic’, and is now laying down guidelines for dealing with something
that, with the exception of genuine cases of clinical depression, largely
exists only in the popular imagination.

Frankly, if you want a few weeks off or, better still, to claim some money
from your employer, go to your doctor and claim you have work- related stress
or some other condition related to work. They will be only too happy to collude
with you, and may even ask how much time off you would like.

Not only that, but when your hard-pressed employer asks their own company-appointed
doctor to get a second opinion, they will find their employee’s own doctor
evasive, unco-operative and even downright obstructive.

It seems to be a cardinal sin to have the temerity to question the judgement
and professional ethics of doctors, even when they diagnose non-existent

One of my clients is a GP practice. Only now, after experiencing such a
claim from one of their own employees, are they beginning to realise the sheer
cost, and waste of time and resources involved when a trite and inaccurate
diagnosis is given by one of their own profession.

Come on all you GPs out there, start taking some level of responsibility for
your actions, and begin to sort out the genuinely ill employees from the

Roger Brown
Personnel and employment law specialist, Endale and Company

There’s more to life than big business

Paul Robertson-Marriott’s comments (Letters, 5 August) are a shameful but
characteristic manifestation of the vision of life held by corporate entities
and supported by their unsavoury HR accomplices.

Anyone succumbing to his logic would imagine that human beings are
subservient to big business and that all other raisons d’etre for humanity must
be subjugated to the needs of institutions.

Most people realise we are all on borrowed time, until we depart in a black
bag. Doctors recognise this reality with special acuity.

They, in common with ordinary people, do not give a damn about the Quebecor
World’s of this world.

Their concerns are about the vulnerable state of all humanity, struggling to
survive in a world where the single-minded manipulation of people is the
ultimate sacred cow, no matter how traumatic the economic and social
consequences are for individuals.

Don’t forget Mr Robertson-Marriott, your black bag is already being

Terry Lunn
FCIPD, Independent personnel consultant

Specialist advice may be more useful

Paul Robertson-Marriott makes some pertinent comments on the information
from an employee’s GP (Letters, 5 August).

In defence of my GP colleagues, however, I think it is fair to say they
clearly feel their allegiance is to their patients. Also, they are not trained
to deal with fitness for work issues.

Then again, I think the sudden change in direction in the advice provided
would merit some further analysis. Had the GP just received the result of some
specialist investigation, or had the employee just started some new treatment
with dramatic results? These would certainly have been among the questions I
would have put to this doctor.

Mr Robertson-Marriott asks how to manage these employees in the workplace.
In such situations, I believe he would have benefited more from the specialist
advice of a qualified occupational physician (that is, with appropriate Faculty
of Occupational Medicine qualifications).

Not only are such physicians trained to deal with the effects of work on
health, and health on work, but it is also easier for them to be objective.
Further information about occupational physicians and the relevant
qualifications can be found at www.facoccmed.ac.uk
or www.som.org.uk

Dr Jacques Tamin
Medical director & chief occupational physician, Interact Health Management

GPs failing to get both sides of story

I have to agree with Paul Robertson-Marriott (Letters, 5 August). What
always grieves me is the fact GPs never take the trouble to balance their
opinion by obtaining any information from the employer about an individual’s
working conditions, or the physical requirements of the job.

They base their decisions on what the employee tells them, which is always
going to be the worst case scenario. Then we invariably end up with a sick note
that signs someone off work for long periods.

Tell me, how can a doctor decide that a person is going to be fit for work
again in six weeks without seeing them for a follow-up during this time? All
this does is make the employee feel they are untouchable, and leaves colleagues
and employers frustrated.

I have read articles where GPs complain about the amount of sick notes they
have to issue to satisfy employers’ requirements.

We always offer light duties or reduced hours if it is appropriate for the
sick employee, but very rarely do we get taken up on this. The employee would
rather sit at home, or out in the sun, until the last minute the sick note is

We have even had cases where ‘sick’ employees have been signed off work, yet
continue with outside interests, such as wedding photography. We were unable to
do anything about this at the time because it was seen as stress-relieving.

Sickness absence is hard to manage, especially in a small company such as
ours, where skills cannot always be transferred to enable efficient cover for
long-term absence.

Presently, we operate our own company sick pay scheme. This guarantees a
certain level of pay for six months, so you will not be surprised to hear this
regularly shoots us in the foot. We would like to change this to try to regain
some control of the situation, but it will require union involvement, as many
years ago it was negotiated in as part of the pay review.

In the meantime, we retain the services of a local GP who can obtain (and
translate) reports from employees’ GPs. We may then follow this with
occupational health consultations as appropriate, and make adjustments to the
working environment where we can. However, it is all costly, it is all time
consuming, and it becomes increasingly difficult to remain objective in one’s
opinion towards the GP and the employee with every case that comes along.

At the end of the day, honest individuals will lose out as changes are made
to compensate for those who take pleasure in abusing the system.

Sarah Kitley
Personnel manager, The Morgan Motor Company Ltd

True diagnosis can be kept from the boss

I refer to Paul Robertson-Marriott’s correspondence (Letters, 5 Aug).

I suspect many HR practitioners are unaware that under Benefits Agency
regulations, doctors are allowed to use an ambiguous diagnosis where the
disclosure of the ‘real’ diagnosis would be prejudicial to the well-being of
the patient.

This will usually be where the doctor feels that the patient, and/or their
employer, should not know that diagnosis. In an employment context, this could
lead to all sorts of problems for employers.

In view of the above, I would be interested to hear readers’ views on how
they would meet their obligations under the Disability Discrimination Act, if
they do not know the true diagnosis.

Brian A Rogers
Operations director, Rowe Cohen Solicitors

Easy for staff to get sicknote from GP

I really identified with Paul Robertson-Marriott about GPs (Letters, 5

In my experience, all employees have to do is to go to their doctor and say
they are unfit for work. How many GPs actually refuse to give a sicknote?

Only today, I received a GP’s report for a warehouse operative, which says
he cannot manage his normal job, but may be able to do something sitting down.
This letter was dated three days after she had already signed him off as fit
for work.

Trish Metcalfe
Personnel manager, Solutions for HR

Risk assessments need a closer look

I sympathise with Paul Robertson-Marriott (Letters, 5 August).

It is all very well for the HSE to introduce stress-based risk assessments.
However, if an employee embarks on sick leave due to work-related stress, after
having completed a risk assessment questionnaire highlighting that they find
their work situation to be free of stress, what recourse do organisations have?

If that employee were to be dismissed consequently for protracted illness,
and then files an unfair dismissal claim, will the employment tribunal support
the word of the doctor who has signed the medical certificates, or give due
consideration to the results of the risk assessment? I would think the former,
but perhaps I am cynical.

I defy any of my colleagues to say that today, they are not spending more of
their time handling stress absence cases than three years ago.

Name withheld

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