Gulbrandsen Pål, Aasland Olaf Gjerløw, Førde Reidun
HELTEF-Stiftelse for helsetjenesteforskning, Postboks 55, 1474 Nordbyhagen.
Tidsskr Nor Laegeforen. 2004 Jan 22;124(2):192-4.
Medical certificates form the basis for important decisions in society, e.g. the issuing of a driver's licence or the granting of a disability pension. We wanted to know how often doctors deliberately write favourable certificates as seen from the patient's point of view, and why doctors do so.
Questionnaire survey to a representative sample of 1605 Norwegian doctors. Doctors who answered yes to the question above gave information about the frequency of such writing of various types of certificates and their reasons for doing so.
1175 (73%) doctors responded. 39% confirmed deliberately writing in favour of their patients. For most types of certificates, a frequency of less than once a year was most common. 55% admitted writing favourably in disability pension certificates more than once a year, 69% so in referrals. The most common reasons given were securing just treatment and quick access to treatment. Many doctors emphasised that by answering yes, they meant that they were indeed writing expert judgments based on correct facts.
Medical certificates deliberately written in favour of the patient is not uncommon. This should lead to a critical discussion of the need for such certificates and medical diagnoses as a basis for resource allocation, rather than the tightening of control over the practice of doctors.
医疗证明是社会重要决策的依据，例如发放驾驶执照或给予残疾抚恤金。我们想了解从患者角度看，医生故意开具有利证明的频率有多高，以及医生为何这样做。
对1605名挪威医生的代表性样本进行问卷调查。对上述问题回答“是”的医生提供了开具各类证明的频率及原因的相关信息。
1175名（73%）医生做出回应。39%的医生确认会故意为患者开具有利证明。对于大多数类型的证明，每年开具次数少于一次最为常见。55%的医生承认每年为残疾抚恤金证明开具有利证明超过一次，69%的医生在转诊证明方面如此。给出的最常见原因是确保公正治疗和快速获得治疗。许多医生强调，回答“是”意味着他们确实是基于正确事实撰写专业判断。
故意为患者开具有利的医疗证明并不罕见。这应该引发对这类证明以及作为资源分配基础的医学诊断的必要性进行批判性讨论，而不是加强对医生执业的管控。
