Transcript - Dr Tony Bartone - Online medical certificates

CRAIG ZONCA:  You know when you're feeling too sick to be at work, but you know you need a medical certificate and that takes money and time, and you've got to leave the house, so you just think I'll go to work anyway - potentially spreading your germs far and wide all for the lack of a medical certificate. Well, would you be more likely to stump up a quick $20 or $30 for an e-certificate? I ask because an online consultation and a doctor shoots it through, or a pharmacist shoots it through on email, this seems like an inevitable consequence of the modern age of the internet. But these days, there's an app for that: e Sickies. Yep, e-certificates. So you can get off work without any problems at all, all by effectively clicking a button and having a consultation using FaceTime, or Skype or some sort of video call. Is it really what we want to see in Australia?

Dr Tony Bartone is the Vice President of the Australian Medical Association. Tony, good morning to you.

TONY BARTONE:  Good morning.

CRAIG ZONCA:  You're a GP yourself, what do you make of this about, you know, things like an app to get a medical certificate so you can ‘chuck a sickie’?

TONY BARTONE:  In this modern age where time is precious and we're all looking for the convenience and the option to save us time, the ability to make our lives even more productive, more on the go, this is not in your health's best interest. It's really opening yourself up to fragmentation of care and not always being able to get the right information and the right advice, or the right care at the right time.

CRAIG ZONCA:  Is this about doctors and pharmacists – I never knew pharmacists could issue medical certificates but I know there are pharmacists that are doing this online. Are they trying to cash in on what is seemingly an Aussie tradition – and I use that term loosely – to ‘chuck a sickie’?

TONY BARTONE:  Pharmacists have been able to issue certificates prior to all this online advancement. But it's important to realise the medical certificate is a really important legitimate and legal document, and it needs to be taken with the respect and with the gravitas that it carries. It is, yes, at the end of the day, a piece of paper and people may seek to abuse it at times, but it does really open up more than just a certification that one is ill and is entitled to a day off.

It validates the person's decision to take the time off, especially when we've got busy workplaces, we've got busy, you know, responsibilities and we feel guilty taking time off work because that pressure continues. “Who's going to pick up the slack? Who's going to actually-you know, when I get back to my desk, it's going to be twice as busy, I've got to catch up and all of these things.” So, it's about putting your health first and understanding that you need to 2 take the time off, that it's a legitimate decision, and that you do need to follow a course of management.

But it also opens up for some people, it's the only time you ever get to see, especially men, we only ever get to see them when they're coming in for a certificate, and it's an opportunity for opportunistic preventative care; picking up things that might have presented much later on, but actually intervening at an earlier stage and make some changes in their health care.

CRAIG ZONCA: So, logging on to the internet or opening up an app and paying $20 or $30 for a medical certificate to take a day off work - to ‘chuck a sickie’, to use the Aussie vernacular - does that diminish the gravitas that is associated with something that is far more serious?

TONY BARTONE: Look, I think that it's really putting your health second and just the convenience factor and speed first. The observation, the information, the examination that comes with the medical examination is really important. As for the information that's built up over time and the relationship that's built up with your family GP who then, just by- sometimes can actually, by just seeing how you are when you're sitting down in the chair can actually pick up that there's something more afoot, more amiss, and they open up the questions to other stresses that are going on at home, in the workplace, concerns about anything else, picking up subtle tiredness, subtle issues with fatigue, or malaise, which may be a pointer for other more serious conditions.

So, it's really- you know, my advice to everyone is develop a relationship with a good family doctor, someone that you can depend on, and then use that to your advantage, use that to your benefit each time you need to have an episode of care.

CRAIG ZONCA: And Dr Tony Bartone is with you on ABC Radio Brisbane; he’s a GP, he's Vice President of the Australian Medical Association.

With these services popping up online and through things like apps on your phone, is there any lobbying being done by the AMA to outlaw those sorts of practices?

TONY BARTONE: It's not our position to outlaw or to seek to outlaw them. What we're really trying to do is put out the advocacy, put out the information about how this can be putting your care at risk, of fragmenting your long-term care, and opening you up to the possibility that things may get missed, and to basically point out that the best care, the best possibility for intervention is obviously one with a relationship that's built on all the history that's gone on beforehand - all the information and all that's built up in your medical file and all the information that's built up on examination and observation, which are a key part of the consultation. And as one of my teachers back many, many years ago told me - and told all of my colleagues - more is missed by not looking than not knowing.

CRAIG ZONCA: But what about for those who take a sick day for no legitimate reason, Tony, and they're like “oh, I need to take a doctor certificate, a medical certificate,” they'd look at a service like something over the internet as being just what the doctor ordered - pardon the pun. What do you say to those people?

TONY BARTONE: Everyone needs to remember that, as I said, a medical certificate is a legal document and it's built on two things; it's built on trust between the doctor and the patient, and confidentiality. Now, obviously a lot of detail goes into the preparation and to the certification that someone is ill. These mediums like the online service open up to potentially a lesser degree of information and observation being available and therefore putting at risk a lot of the genuineness of each certificate in each episode of issuing a certificate. But we've got to understand that there is a trust, we really do have to take sometimes a lot of the information that's presented in the trust and that confidentiality that underpins a doctor-patient relationship.

CRAIG ZONCA: Are you suggesting that those offering these sort of services online are trying to cash in on the illegitimate ‘taking a sickie’? Which does happen in Australia. You know, it's said to cost Australian businesses over $30 billion a year - absenteeism - and the fact of, you know, when there's a public holiday on a Tuesday, the number of people that might take a sickie on a Monday, for instance.

TONY BARTONE: Look, I'm not trying to suggest that, but what I am saying that is in the quest for speed, in the quest for convenience, in the quest for what seems to be - on paper - a more appropriate solution for some people in their busy life, they're opening themselves up to a lesser standard of care perhaps and therefore also availing people who seek to potentially, maybe, try to use the system to their advantage to perhaps obtain one by, you know, perhaps a lesser standard of care. But I would suggest to patients, if your health is important to you, if your long-term care is important, you would really seek to use the time-honoured traditional method of seeing your GP and having the symptoms observed, examined and diagnosed, and a plan implemented. And all the other things that underpin that consultation.

CRAIG ZONCA: Tony, really appreciate your time. Thank you.

TONY BARTONE:  Not a problem. Thanks very much.

23 June 2017

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