‘We can’t say they don’t have it’: Patients seeking impossible clearances for coronavirus

Doug Hendrie

10/06/2020 4:02:18 PM

The RACGP has created a template to help GPs grappling with requests for employer-mandated medical clearances that ‘guarantee’ patients are virus-free before returning to work.

GP and patient
Medical clearances for coronavirus are risky and cannot be definitive, experts say.

The RACGP’s updated letter to employers states that doctors cannot routinely provide COVID-19 clearances for those returning from overseas or healthy people who have had contact with unwell people.
The letter calls on employers to consider whether medical clearances or certificates are needed.
The issue comes as some employers move to ensure staff safety by requiring returning workers to prove they do not have the SARS-CoV-2 coronavirus that causes COVID-19.  
But, as Professor Glynn Kelly told newsGP, GPs cannot guarantee patients do not carry the virus, even if they take a history, do a clinical examination and have them tested.
‘There’s no way the GP can say a patient does not have COVID-19. People can be asymptomatic while still infectious,’ he said.
‘Even if you have a test result saying they don’t have COVID-19, you can’t guarantee it – because the tests are not 100% accurate.
‘This has medico-legal complications. If I say someone is clear and they go back to work and they have the virus, it’s not good for the community and it’s not good for me.’
As a result, issuing clearances for the coronavirus is better avoided if possible, according to Professor Kelly, who is Chair of the RACGP Specific Interests Disaster Management network.
But given some employers are requiring these clearances, GPs could consider using the RACGP form letter for patients ‘doing it tough’ and desperate to get back to work.
‘All we can do is say that we assessed the patient who has stated they are symptom free and that they have no clinical features of a viral infection,’ Professor Kelly said.
‘But we can’t say they don’t have it. 
‘Employers are doing the right thing to protect other workers, but they have to realise that a clearance is not a guarantee.’
Department of Health guidance for employers states that employees who have completed a 14-day quarantine period who did not develop symptoms do not need a medical clearance to return to work.
‘Employers should not ask these employees to be tested for COVID-19 in order to return to work,’ the guidance states.
MDA National professional services manager Dr Sara Bird told newsGP her medical defence organisation is receiving many requests for medico-legal advice in this area.

‘Some employers are seeking medical clearances for COVID-19 [and] some employees are concerned about returning to their workplace because of chronic illnesses and are seeking certification about fitness to work,’ she said.
MDA National medico-legal manager Dr Jane Deacon notes in published advice that that doctors are obliged to provide factual information in response to any request for a coronavirus ‘fitness certificate’.
‘[T]his does not mean the doctor must follow the format requested by the patient or the employer,’ Dr Deacon states.
‘There is no testing currently available to demonstrate conclusively that a patient is not infected with COVID-19.
‘Doctors can provide a certificate or a letter dated the day the patient was seen, and this could include relevant information such as the patient presenting symptom-free, whether they have complied with public health guidelines … and the outcome of a physical examination.
‘The history and examination should be clearly documented in the medical record.’
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