The Ministry of Health (MOH) wants to tighten its rules on issuing medical certificates (MCs) amidst concerns that doctors are giving them out too freely.

This comes after the ministry received feedback regarding the excessive issuance of MCs following outpatient medical service consultations, and that some MCs were given for non-medical reasons.

MOH is currently seeking feedback from doctors on a proposal to amend the Healthcare Services Act to tighten the conditions for issuing MCs, the ministry said in a circular sent to doctors on Apr. 22, seen by Mothership.

The allegations

The ministry pointed out that particularly in the context of teleconsultations, MCs had been issued solely based on patients' self-reported reasons for consultation without any proper assessment by a medical practitioner if there were such conditions that warranted an MC.

"MCs were issued when patients mentioned that they had just wanted a certification to skip work or school, but they were not sick," MOH said.

MCs were also repeatedly issued to the same patients without referring them for physical consultations for further assessments to check if they were indeed unwell.

Proposed regulations

The ministry intends to impose a requirement on doctors to include their name and medical council registration number on every MC issued.

In addition, any doctor found advertising or allowing the practice that the issuance of MCs could be "anonymised" would be breaching this regulation.

A breach in regulation may result in the revoking of the medical practitioner's license.

The ministry may also conduct inspections or audits, or request the relevant procedures and policies with regard to the remote provision of outpatient medical services. Doctors who fail to the code and guidelines may be referred to the professional watchdog for further action.

Medical practitioners who would like to provide feedback on the new requirement can email in to [email protected] by May 20.

Obligations as a doctor

MOH and the Singapore Medical Council reminded all doctors to adhere to the latter's Ethical Code and Ethical Guidelines, which state that "medical certificates must be issued to patients only on proper medical grounds arrived at through good clinical assessment”.

Signed jointly by Professor Kenneth Mak, director-general of health at MOH, and Professor Chee Yam Cheng, SMC’s president, the circular said that doctors cannot take extraneous factors into consideration when issuing MCs.

These factors include who pays for the consultation, what benefits the patients may receive or what employers' preferences may be.

"[An MC] must be made in the context of an existing patient-doctor relationship and is premised on the duty of care the doctor owes the patient arising from this patient-doctor relationship," the circular said.

Top photo via National Cancer Institute/Unsplash