This issue of SMA News is focused on telemedicine and medical certificate (MC) issuance. I have previously written about my experience with telemedicine in my July 2024 column, and I would now like to share some of my thoughts about MCs, which are issued by doctors to certify that patients are unfit for work or school, or to excuse patients from specific duties.
Sometimes, patients who are consulting their doctors for chronic medical conditions may request their doctors for MCs, even when they are well enough to return to work. One of the reasons they do so is that their companies do not provide them with paid time-off for medical appointments. If they obtain an MC, they are entitled to paid sick leave under the Employment Act.
The Ministry of Manpower addresses the issue of using sick leave to attend a doctor's appointment on its website, stating that "In accordance with the Employment Act, employees with an MC from an approved doctor are entitled to paid sick leave. So if you see a doctor and are issued an MC, you are entitled to paid sick leave for that appointment. Employers are also encouraged to be flexible and supportive by providing paid time-off to employees who need to see a doctor for necessary medical appointments. On their part, employees should inform their supervisors of such appointments as far in advance as possible."1
There may be a misconception that MCs can be routinely issued for clinic attendance. The website of an HR provider has an MC guide for employers which states: "Employees dealing with ongoing health issues, such as diabetes or arthritis, may require periodic time off to manage their condition. An MC ensures that these absences are documented and understood by the employer."2 This interpretation of the role of MCs is incorrect.
The professional conduct of doctors is governed and regulated by the Singapore Medical Council (SMC). The SMC Ethical Code and Ethical Guidelines 2016 states in Section B4(1) that "MCs must be issued to patients only on proper medical grounds arrived at through good clinical assessment. You must not take into consideration extraneous factors such as who pays for the consultation, what benefits the patients may receive or what employers' preferences may be."3
The SMC Handbook on Medical Ethics 2016 expounds upon this further by advising in Section B4 that "MCs are issued either to promote patients' recovery from medical conditions, or to protect third parties against possible harm from the patients' medical conditions. Unless there are clinical reasons for issuing MCs, well patients who consult you in your clinic should only be given certificates of attendance for their employers."4
It is for the above reasons that doctors may choose to issue certificates of attendance, or "time chits", instead of MCs for their well patients. In my opinion, it is important that employers and patients understand that MCs are not meant for clinic attendance. With this understanding, employers can implement appropriate leave policies to support their employees who have chronic medical conditions that require them to see doctors.