{"id":24541,"date":"2013-02-15T15:17:43","date_gmt":"2013-02-15T14:17:43","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=24541"},"modified":"2013-02-15T15:17:43","modified_gmt":"2013-02-15T14:17:43","slug":"julian-sheather-should-i-sign-him-off-sick","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2013\/02\/15\/julian-sheather-should-i-sign-him-off-sick\/","title":{"rendered":"Julian Sheather: Should I sign him off sick?"},"content":{"rendered":"

\"\"Thou shalt not judge<\/em>. A GP asked me recently whether he should sign patients off sick when he thought they were swinging the lead. I talk to a lot of GPs and I get asked a lot of difficult questions \u2013 it goes with the ethics territory \u2013 but this one looked like a no-brainer: if you\u2019ve got good reasons to believe that someone is not sick, don\u2019t sign them off. Why lend your hand to a fraud? I\u2019ve also knocked around this territory long enough to know that, for good and ill, things are never, ever that straightforward. We were in a less than affluent part of Manchester. Outside high rises lowered over wind-scoured scraps of grass. Employment levels in the area were as low as the cloud cover. I know they\u2019re trying it on, he said. They\u2019re totally capable of working, but they can\u2019t be bothered. Across the table a GP colleague \u2013 did it make a difference I wonder that she was, well, a she? \u2013 bristled very slightly. It\u2019s not that straightforward, she said. Psychosocial burdens are as debilitating as physical ones. There is more to sickness than aberrant biology. I listened to them talk for a while and it was almost as if there were two different kinds of medicine in the room, two different versions of the GP’s job, two different takes on the human predicament. Are we the products of our environments or of our choices? Does medicine have a role in dealing with social as well as biological pathogens? I am not sure I have ever seen the struggle over the soul of medicine dramatised quite so urgently.<\/p>\n

I have been brooding on that conversation ever since. The first doctor, let us call him Dr A, working, loosely speaking, on a biomedical model, seemed to be making the following assumptions:<\/p>\n