What made you want to do the work you do? Please share the full story.
For over two decades, while working as a general practitioner for the NHS, I have witnessed many patients struggle to receive the timely documentation (such as sick notes, fit-to-fly letters and insurance claims) that they require. It typically took me a matter of minutes to reach my decision as a clinician; however, it would take several weeks for an administrator to complete the necessary paperwork. This was genuinely detrimental to patients who require this documentation to return to work, travel for various family emergencies or receive the benefits they are entitled to receive.
As a GMC registered medical review officer with MedicalCert, I was given the opportunity to continue using my clinical judgement in a remote and efficient manner and to do so immediately following a face-to-face consultation. My interest in both lifestyle medicine and male health fits nicely here. A patient often seeks a certificate after delaying discussing their illness or chronic health problems for months.
How is AI changing your business? What changes are you making to adapt?
AI has made a big difference to the way MedicalCert operates. By managing much of the questionnaire administration for us, AI is able to indicate when a submission has not been completed or identify which cases are on the verge of needing nothing urgent to be escalated. However, AI does not play any role in making clinical decisions regarding an applicant’s fitness for work; rather, each certificate is still reviewed and signed by a GMC-registered doctor such as myself who will ultimately decide whether to issue the certificate. Without the assurance that the certificate will be signed by a medical professional, neither the patient nor employer will have confidence in it.
To adapt to this change, I am advocating for the development of systems that are designed to remove workflow friction rather than create additional dashboards and other complications. Most clinicians do not want another digital tool but would prefer systems that integrate seamlessly into their day-to-day clinical work and enhance continuity of care without adding to the workload of doctors.
What are the 3 things you like best about your work and why?
I appreciate that I can provide a clinical decision to a patient on the same day. This takes away the need for the patient to worry for weeks about what will happen, particularly with men’s health issues or requesting an ‘absence note’ for a lifestyle issue. In NHS General Practice, for example, a patient will wait around two weeks for their routine appointment to obtain the above note, therefore during that time they cannot return to work or deal with their underlying health problem.
To be able to view the patient’s notes remotely and send a signed PDF back to them the following morning is a truly valid way of repairing a broken link in the system and allows me to use my clinical judgement in the way that is most valuable to the patient.
What are your greatest 3 skills and how have they helped you succeed?
I have extensive experience in both surgery and general practice, which has been instrumental in my ability to make quick and safe decisions as a doctor and to identify red flags in patients who I cannot physically examine. This has been possible because I have developed a wide breadth of clinical knowledge from my early postgraduate training in surgery (MRCSEd) through over fifteen years of experience as a GP on the GMC register.
I also use my training in sexual and reproductive health and my interest in lifestyle medicine to provide patients with practical, evidence-based advice that they can act on.
Tell us about a time you were dead wrong about something.
When a patient came to me for a fit-to-work note following a minor injury, I was surprised by the outcome of the case. While reviewing the patient’s questionnaire, it was clear that the patient exhibited symptoms indicative of undiagnosed type 2 diabetes and I was not going to issue the certificate as requested. Instead, I escalated the patient’s case and arranged for urgent blood tests, following up afterward to ensure the patient received appropriate care.
What I had anticipated would be an administrative chore turned into an entire new diagnosis and very potentially prevented major medical consequences. It demonstrated that an inexpensive online certificate service is not only capable of identifying a significant medical issue, but also that the amount of time you invest in reviewing a patient’s information is important, and that doing so could help eliminate the possibility of overlooking it.
What is the biggest challenge you face each day and how do you handle it?
Daily, I have to balance providing clinical rigour with working through numerous remote questionnaires submitted for same-day service. There is great pressure to issue certificates as quickly as possible; however, issuing a certificate based on speed, rather than through assessment, is not acceptable, especially when the patient has described experiencing chest pain, a mental health crisis, or a travel risk that requires immediate action.
To accomplish this, I will never issue a certificate unless there is sufficient evidence to do so. In doing so, I may lose some business revenue and the patient often becomes angry with this decision. Additionally, I implement the use of structured questionnaires and clear escalation criteria in order to ensure consistency in my clinical judgement from my first review of a patient’s documents to the last review.
What is a habit you try to stick to and how has it helped you?
Before providing any certificates for my patients, I allot thirty minutes every day to review rejected cases and escalations. I adopted this habit as it gave me an opportunity to slow down during a time when online healthcare would otherwise be more transactional in nature. By reviewing cases earlier in my practice, I could identify reasons for inconsistencies and develop records that could be defended if challenged.
The habit of reviewing cases has definitely aided in my success. It helps avoid confusion in how I document my recommendations, ensures that my recommendations for patients’ health and lifestyle are based on current scientific evidence rather than past experience, and ensures that my patients receive the most thorough review possible, regardless of how busy or rushed I am at the time of issue.
How do you celebrate your victories?
I celebrate my successes by documenting it in a small reflection of the case and passing all the accolades to my team instead of throwing myself a party or treating myself to something materialistic. An example of this is when a patient receives a same-day certificate allowing them to fly for urgent family matters. I write down what went well with the experience, acknowledge all those who reviewed it, and afterward I’ll take that success and create an updated protocol.
By doing it this way, I’m keeping my focus on the impact to the patient and learning vs. focusing on myself or my accomplishments. It also means that because of one successful experience, I can create an improved experience for the next 100 patients. That gives me much more satisfaction than just the short-lived benefit of celebrating my victory.
What is your favorite book and why?
The book The Emperor of All Maladies by Siddhartha Mukherjee is my favorite book. The book tells about the long human fight toward finding a successful treatment for cancer – a fight that has involved a lot of uncertainty. The book reminds me that medicine is complicated; medical treatment is not as easy as following a treatment plan or receiving a piece of paper with a doctor’s signature on it. This thought process has affected my general practice of medicine, including the areas of Men’s Health and Lifestyle Medicine, where my goal for my patients is often to help them change a habit or come to terms with their diagnosis.
Reading The Emperor of All Maladies also affects how I run remote consultations with my patients; I know that all I get in the questionnaire is the start of the patient’s story, and that the questionnaire is not the complete story. The reading of Mukherjee’s book reminds me to approach every patient’s story with humility, and to look for the parts of the story that do not fit what I expect.
If you do charity or volunteer work, what is it and why do you do it?
My many years of working in the health profession while volunteering through community health initiatives that promote the importance of Men’s Health Screening and Lifestyle Education have convinced me that many men tend to put off seeking medical assistance until after their condition becomes urgent (like a heart attack or stroke). A simple check of blood pressure or a discussion about diet and exercise may help prevent fatal events, while also allowing for more relaxed discussion than what occurs during a doctor’s appointment.
My experience in this area is what allowed me to become successful when I transitioned to practicing online medicine. I now make it a point to devote extra attention to male patients who submit symptom questionnaires related to fatigue or stress. In addition, I am not willing to provide sick leave certification unless there is clinical justification – regardless of whether or not my patient is requesting me to do so.
Who has been your biggest mentor in life (personal or professional) and how have they helped you?
I drew the most knowledge from an experienced GP educator during my early days of working in the field of medicine. This person taught me how to make safe choices with incomplete data while also allowing me to learn that it is acceptable to act uncertainly when dealing with patients without losing their confidence.
They dealt with challenging situations by thinking aloud, acknowledging their doubts, and providing complete details of their plan to protect themselves and the patient from any potential harm. As a junior doctor, I had been trained on how to be confident in presenting my care plans—for instance, by being taught that I have to be able to answer any question that may arise.
The greatest contribution they made to me was insisting that I justify all my clinical decisions in writing. This has been invaluable in my work as a remote GP reviewer, as it provides a solid foundation. Because of this training, I am now capable of reviewing a patient’s history, identifying warning signs, and attempting to resolve an issue based on an established, unambiguous set of criteria.
Just for fun, what is your favorite ice cream flavor?
Caramel