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Why Do Doctors Find Completing Legal Forms So Difficult? - Dr Mark Burgin

05/09/19. Dr Mark Burgin BM BCh (oxon) MRCGP looks at the factors that impair a doctor’s ability to comply with legal instructions when completing forms.

Doctors must complete legal forms, from prescriptions and sick (now fit) notes to death certificates and x-ray requests the medical role is intimately associated with the law.

These responsibilities are important to society, yet errors are commonplace and seemingly tolerated unless the patient comes to harm.

One reason is that doctors themselves are not embarrassed by their failures and often appear to see their ignorance of the law as a badge of honour or a joke.

If a doctor made a clinical error they would seek out training to understand why the error had occurred and how to avoid it in future, but not with legal errors.

Example: Fit Note Law Summary

  • Doctors must perform a suitable clinical assessment.

  • Assess the functional effects of the health condition.

  • Specify health condition as precisely as the doctor’s knowledge permits.

  • Fitness for work in general not job specific.

  • Cannot issue if patient only has personal or social problem.

  • If fit within limits must give reasons for recommended arrangements.

  • Employer must perform suitable risk assessment.

Knowledge Gaps

Lack of formal training in medical school about legal issues is worsened because those teaching will view anything that is not ‘proper medicine’ as a waste of time.

Training of legal issues by doctors often feels like the blind leading the blind where no one looks at the regulations and the junior copies the mistakes of the senior.

These knowledge gaps are so extensive that most doctors fail to comply with the regulations several times each day but are only aware of a small fraction.

These gaps are therefore unknown unknowns where the doctor does not recognise that there is a problem because no one enforces the rules.

Legalese

Laws are generally a very brief statement buried within a large statute and accompanied by complex documents called practice directions, code of practice or guidance.

A short summary of the rules that guides the doctor with simple language to ensure that they can complete the task to a basic standard is rarely available.

The alternative for a doctor is to try to find the right documents and plough through the legalese that is contained within them to find the gems buried there.

Whilst ignorance of the law is no excuse I feel that it is not wholly the responsibility of individual doctors to read the source material so they can the rules.

Motivation

It is likely that current solutions will be ineffective, the medical examiner of death certificates will meet resistance, more advice will remain unread.

It is important to get doctors to understand why they should complete legal forms correctly and buy into the idea that doing it right will have benefits for their patients.

The GP who completes the sick (fit) note correctly gets into trouble with their patient who is not expecting to told that they can do adapted duties if their employer agrees.

GPs have little training in functional assessment (disability analysis) so may not be able to carry out a suitable clinical assessment without support.

Poorly designed forms

Many forms are designed by lawyers and doctors in a meeting and not developed in practice so that GPs can challenge the inadequate space on the form for an opinion.

The medical condition section is about 3% of the area of the fit note and will prevent the GP from specifying the health condition as precisely as they should.

The comments including functional effects has about 17% of the area but should also include words that give hints as to what is required such as ‘mobility’ and ‘care’.

Space needed when the form is completed by hand will be greater and space can be increased making any typed advice to the GP on the form greyscale so it can overwritten.

Conclusions

Understanding the reasons why doctors frequently fail to understand their duties when completing legal documents is useful to constructing improvement strategies.

Explaining how much money is spent on sickness benefit, the consequences of the wrong diagnosis on a death certificate or MHA sectioning paper can help improve doctor’s interest.

Ensuring that there is a simple summary that can accessed easily and removing disincentives against doing the right thing can address the reasons behind knowledge gaps.

Recognising that many doctors do not understand what information is required for the legal tests can improve the design of forms and the quality of training.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register and audits medical expert reports.

Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

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