I refer to the article “MOH to tighten rules on MCs after feedback on docs issuing them excessively or improperly” (May 12).

We should not be asking “Why are doctors giving out MCs liberally?” but rather, “Why do we need MCs?” Part of the answer is that doctors are caught between patients and employers.

Many developed countries do not require MCs, or medical certificates, as evidence of someone being unwell. Exceptional circumstances such as missing a court hearing or missing formal examinations do require MCs, but MCs are generally not expected.

Unfortunately, this is not the practice locally. Employers do not seem to trust workers who call in sick, and despite this topic having been brought up several years ago, there has been little progress made towards fostering a culture where MCs are the exception and not the norm.

Doctors are expected to be arbiters in determining a patient’s fitness for work, which goes beyond “medical” fitness to also incorporate psychological and social well-being.

While doctors can help with psychosocial concerns to some extent, many factors involve policy and culture. Factors such as flexible work arrangements, minimum annual leave quotas and support for workers who are also caregivers should be examined and improved upon to minimise these systemic barriers to well-being. Perhaps the duty of care of a doctor is also to act as an advocate for his patient and provide MCs to someone who really does need a mental-health day off but cannot get it otherwise.

I hope the article will spur greater discussion on not just the rights and responsibilities of doctors, but also those of worker patients and, especially, employers. Furthermore, it should probably prompt a detailed examination of what can remain as guidelines when it comes to MCs and employment arrangements vis-a-vis what should be codified into law to better define the duties of doctors, workers and employers.

Perhaps then we can look forward to a future where trust replaces MCs when it comes to a sick patient requesting time off.

Lee Yuan Hwa (Dr)