Minimising risk for GPs providing medical clearances

Morgan Liotta

19/04/2018 11:47:15 AM

How can GPs ensure they are safeguarded against any potential risks when approached by a patient seeking medical clearance?

GPs can minimise any potential risk involved in providing a medical clearance by ensuring they initially obtain as much relevant information as possible.
GPs can minimise any potential risk involved in providing a medical clearance by ensuring they initially obtain as much relevant information as possible.

GPs are often presented with situations in which a patient requests medical clearance for a health-related area, from fitness programs at gyms to medical trials run by health researchers.
However, medical clearances can expose GPs to a number of potential risks when not properly assessed. In circumstances where harm arises in relation to the patient’s participation in the program, a GP could face claims or complaints. Complaints could also arise if a GP refuses to provide the medical clearance.
Dr Julian Walter, medico-legal adviser at medical defence organisation MDA National believes a GP has two key roles when providing medical clearances for patients.
‘Providing an historical summary of what might be relevant to the query, and looking into the future to ensure something that hasn’t been considered and is raised as a risk is either excluded or confirmed as a problem,’ he told newsGP.
Requests for medical clearances come in all shapes and sizes. Some organisations request a letter, while others have comprehensive forms for GPs to complete.
In the instance of providing a medical clearance for a research trial, it can often be difficult to determine what risks there are for patient participation if limited information is provided about what the trial involves.
For example, providing a medical clearance for a fitness certificate involves the GP certifying that the patient is physically fit to perform specific activities, such as working in a gym, although the GP may have limited insight into the specifics of that role.
Dr Walter advises GPs to exercise caution when dealing with ‘open-ended questions’.
‘For example, if a gym writes to the doctor to ask, “Is it okay for this patient, now gym member, to attend the gym?”, the doctor is answering a question for which they have no sense of what the data is,’ he said.
‘What is this patient going to be doing for exercise? Is it gentle, moderate, or high-intensity exercise? Is there a musculoskeletal risk?
‘The GP is operating on very limited data so their task is incredibly difficult. It’s a non-specific request with very little information and that makes the response very difficult to provide.’
Dr Walter believes this is where the GP can potentially be exposed to medico-legal issues, when harm can arise in relation to the patient’s participation in the activity where the risks have not been properly assessed, based on a lack of initial information.
‘I suspect a lot of these third-party requests are expecting that the role of the GP is to shift the risk that might attach to something going wrong,’ he said.
‘Presumably, if it’s a worry of the GP then that’s not really their role to take on the risk of any future adverse event.’
To ensure the most efficient ways to mitigate any potential medico-legal risks, Dr Walter recommends limiting details provided in medical clearances to exactly what the GP knows, to be honest and specific, and to provide any other information they consider relevant.
‘It’s important for the GP to start from a position of informing the requesting party of what they know about the patient and perhaps what they don’t know about the patient, and making sure that the facts on which their information is based are also understood, in terms of what the role is,’ Dr Walter explained.
In some cases, it may be necessary to refer the patient to another expert, such as a physiotherapist or musculoskeletal specialist.
Dr Walter believes that ensuring all ground is covered from the beginning helps to protect the GP from possible risks and to avoid adverse patient outcomes.
‘Firstly, the GP needs to understand what it is that they are being asked to do,’ he said. ‘Then assess if they are the right person to answer [the request for the medical clearance] and, if not, then think about who is. It may be that the patient needs to be referred to someone with specialist expertise.’
Contact MDA National for more information.

GP poll
Following a number of member queries regarding possible medico-legal obligations or consequences of providing medical clearances, the RACGP is asking GPs how comfortable they are responding to patient requests in this area.
Access the latest issue of In Practice to participate in the RACGP’s poll on medical clearances.

doctor-patient-relationships MDA-National medical-clearance

newsGP weekly poll What is your chief concern with role substitution?

newsGP weekly poll What is your chief concern with role substitution?



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