Toon P D
Department of General Practice and Primary Care, St Bartholomews Hospital, London.
Br J Gen Pract. 1992 Nov;42(364):486-8.
As well as acting as personal physicians, general practitioners are often asked to provide medical certificates, enabling patients to obtain benefits. In these cases doctors may act for the state, for other institutions or individuals, or as an advocate on the patient's behalf in a dispute. The ethical basis of this activity differs from the therapeutic doctor-patient relationship. Difficulties are particularly likely to arise when doctors are called on to combine the roles of therapist and certifier. Although this is often convenient and saves money, the damage to confidentiality and to the primary therapeutic relationship which may result must be weighted against this. The limitations of such certificates should also be borne in mind. Fairness and the preservation of the therapeutic doctor-patient relationship are best served by restricting the role of the personal doctor to the provision of clearly defined factual information on which others, who may be medical or non-medical, can make the final judgement.
除了担任私人医生外，全科医生还经常被要求提供医疗证明，以使患者能够获得福利。在这些情况下，医生可能代表国家、其他机构或个人行事，或者在纠纷中作为患者的代言人。这种活动的伦理基础与治疗性医患关系不同。当医生被要求同时承担治疗师和证明人的角色时，尤其容易出现困难。虽然这通常很方便且省钱，但必须权衡这可能对保密性和主要治疗关系造成的损害。还应牢记此类证明的局限性。将私人医生的角色限制在提供明确界定的事实信息上，由其他可能是医学或非医学专业的人做出最终判断，这样最有利于公平性和维护治疗性医患关系。
