Sick leave certificates or MCs are giving a lot of problems

Long time ago, while I was working as a Locum or replacement doctor in one of the Chinese clinic in Damansara area. One morning, a person came into the consultation room and immediately “requested” me to prescribe the same vitamins he was given on his last visit. He was working in one of the our panel companies and although most of the panel companies usually instructed the private clinics not to prescribe vitamins, I had no choice but to agree to his demands as he was talking with a stern face like ordering and the medicines were also not expensive and was just asking for three day’s supply only. And I also just wished to avoid the unnecessary confrontations with the patients because if unsatisfied, twisted complaints by the patients or customers could damage our reputation and good name as the saying goes, customers are always right.

Then he ‘demanded’ me again to issue another three days sick leave (he used the words MCs as we used to call here in Malaysia). Then only I looked back his records carefully and noticed that there were no records of his illness on that day: no complaints, no records of the doctor’s physical examinations nor any diagnosis nor any other medication for any disease were written in his medical records. There was just a record of three days’ prescription with vitamins and three days of MC.

So I politely told him that I could not simply give MC like that and asked him whether he had any health problems which I could examine and attend. Actually I spoke to him with respect and soft voice as he was an old man and I actually intended to help him with one or two days’ MC after listening to his complaints or problems; physical or psychological problems or work related problems or any other serious social problems.

However, he suddenly hit my table with his fist and shouted to me, “What kind of doctor are you? I have never seen that kind of doctor”

He suddenly stood up aggressively and so I also as an automatic reflex stand up to protect myself and retaliated to him with the same voice and manner, “What kind of patient are you? I have never seen that kind of patients before. After all you are even not my patient. You just walked into my room to ask for the vitamins and demanded for MCs. Few days ago you took MC for three days without obvious sickness, now you demanded another three days leave. If you are lazy, don’t come and disturb us, apply your own leave or just resign from your work!”

He suddenly grabbed all his company Medical chits that we used to bill his company. That papers authorized him to seek treatment at the clinic on the company’s account and he rushed out of the clinic. There were dozens of patients waiting outside and I was so angry with his behaviour and as a spontaneous response, which I had never done on any patients before or after that incidence, I followed behind him up to his car, shouting to him to give back the company chits so that we could bill the company for the “consultation”, as he had already wasted our time.

Actually there was one nurse only at the clinic and after registration and dispensing the medicines; she was busy with the monthly billing and accounts. Later that day, MC man rang up to the clinic owner/doctor and then next day only I knew that he was the biggest boss of one GLC or Government Linked Companies. When the nurse registered him at our clinic, she just copy the name from the IC without putting his Honorific titles in front. She wrote his job in Malay Pengerusi of that company name in Malay language only. I was quite naive because I failed to realize that he was the Chairman and CEO of one of the biggest company in Malaysia. Although I was wrong, he as a great man appointed by the PMs in various high positions should not behave like this. Asking vitamins and 3+3 days MCs without even telling his problem is too much. I think no one would dare to question him even if he just give excuse and stay in his house without any official leaves.

In Ng and Lee, we witnessed other doctors cars scratched, tire punctured or threatened with assaults. I was called names, shouted at and some threw away the medicines when I refused to give MCs without illness. They went to other clinics to get MCs and even tried refund for non-panel clinic expenses by complaining that panel clinics are useless.

One factory near our clinic and another factory in Pudu area complaint to my boss and accused me WRONGLY that I was issuing MCs. And even stopped panel contract to our branch. Most of their staff got allergy due to their metal powder, dusts and smoke. When the staff came with red eyes, the factory staff nurse rang me up and complaint that most of the staff just put the cigarette ash into the eye and rubbed till red. She ordered me not to give MCs. One Malay couple showed the proof that their child was in ICU for 10 days with Dengue. As they could not cook, they took outside food and got food poison. HR officer was angry because I give MC to them. They should even help their staff in that kind of situation. Another Malay couple came and told me that their child passed away the previous week, they went to the graveyard that day and the wife fainted. I treated and issued MC, the factory nurse was angry. One Indian girl came with a superficial cut on the wrist, which I stitched and had given 2 days’ MC. Next month, Jusco staff saw her fainted while coming down from taxi and sent to our clinic with a wheel chair. She had her personal problems, insomnia, tension head etc.. blah, blah, blah….She failed to report for duty in the morning. I issued half day (morning) MC and advised her to go to work or report to the factory clinic. But the nurse and HR just think that their staffs were racially lazy and angry with me for issuing MCs.

One Jusco staff with the similar name as a famous political leader just ask me to give MC as he could not sit for the exam held in open university. As I opened the door for him he ask at the door even before we took our place. I told him that we open the clinic to treat the disease but not for issuing MC. He became angry so I told him to reveal his problem so that I could help if he is really ill. He told me that he had a boil on the buttock, refused to allow me check and went out of the clinic shouting abuses. I went to talk to his manager who was also my patient. But he had told the different story and had presented with the MC from other clinic. The manager obviously tried to protect his staff. But after few months, that staff was caught stealing the video camera from another Jusco outlet and was expelled from work.

One way to get rid of MC problem

AFTER a lapse of 15 years spent teaching at local universities, I have recently returned to general practice. I find that private sector employees seeking medical certificate (MC) for minor inconveniences are putting doctors in an awkward situation.

More than two decades ago, I suggested that we should follow the example of Britain and some European countries in dealing with this problem effectively.

There, employees are given a fixed number of days in a year they can be absent from work due to minor problems, ranging from a hangover, headache to stomach upset. They need not go and get an MC and they just report to their employers.

Over and above this fixed number of days, employees are allowed a fixed number of “sick leave” days, for which they should see their family doctor and obtain an MC.

This system has cut down unnecessary visits to the doctor on the pretence of being sick.


High sick leave not docs’ fault By LIM AI LEE

PETALING JAYA: Doctors should not be blamed if workers feign illness to get sick leave, said Malaysian Medical Association (MMA) president Dr David K. L. Quek.

“Some clever malingering patients can get away with falsely presenting themselves and getting medical chits or certificates (MCs), but the fault is not with the doctor but with the patient or worker,” he said.

Dr Quek was responding to a re­­port in Sunday Star last week quoting the Malaysian Employers Federation (MEF) as saying that Malaysians have one of the highest MCs rate in the region, with sick leave costing employers RM1bil annually.

MEF executive director Sham­suddin Bardan had claimed that workers faking illness to get sick leave had become a rampant practice.

Dr Quek stressed that the MMA did not condone the giving of MCs to just anyone who requested for it.

He, however, admitted it could be difficult to detect a malingerer as some illness had very little physical signs which could be documented.

“There is no machine or test which can find for every occasion, someone truly ill to the point of justifying sick leave or not 100% well.

“How can you assess whether the muscle or joint aches are true, or whether the headache is real? We have to trust the patient when they complain to us of their symptoms.”

Dr Quek suggested that human resources departments of every company kept in close touch with their panel doctors and alert them to the problematic worker who appeared to be taking more MCs than expected.

“If they can prove that some of these workers have been playing truant or abusing their sick leave, then these should be alerted to the panel doctors to make them more vigilant the next time.”

He felt it was unfair to blame doctors if they were more sympathetic than employers.

“Some doctors are more stingy on MCs while others more lenient, but this doesn’t mean that either is wrong. This is just how human beings are.

“Some of us would work through a bad cold or sprained shoulder or elbow and refuse to take time off, while another cannot bear the discomfort and would opt to rest at home and not work. We each have different thresholds for work ethics and commitment.”

He added that the principle of issuing any MC should be based on the doctor’s assessment of the need for the leave to recuperate.

Citing his experience as a specialist, Dr Quek said he gave “extremely few” outpatient MCs.

On black sheep in the profession who gave out MCs freely or sold them, Dr Quek said the number was very small.

“If any doctor is found to be selling MCs or abusing his or her privilege, then action can be taken by lodging a complaint with the Ma­­laysian Medical Council.

“It is definitely less than one in 500 doctors and we have around 7,500 general practitioners.”

An online poll conducted by The Star, posing the question: “Do you agree with the MEF that many Malaysians feign illness to get MC?” received 33,950 votes as at 2.50pm yesterday.

About 78% of them disagreed with the MEF that many Malaysians feign illness to get MC, while 20% agreed. A mere 3% confessed that they had done it in the past.



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