What made you want to do the work you do? Please share the full story.
I co-founded MedicalCert to eliminate barriers between patients and their medical documentation as well as access to healthcare in general. My volunteer experiences in São Tomé, India, Taiwan, and beyond revealed to me how barriers that prevent patients from accessing medical documentation are detrimental. Through clinical training in Africa and Switzerland and further education in the UK through the NHS, I have frequently encountered patients who have had difficulty getting appointments for sick notes or travel clearances when needed.
MedicalCert allows patients to fill out an online questionnaire from home and receive the same day a signed medical certificate from a GMC registered doctor after a remote review of their questionnaire. This is the same way I would arrive at the same decision in a face-to-face consultation but without having to wait the standard amount of time for the consultation.
How is AI changing your business? What changes are you making to adapt?
MedicalCert is experiencing a shift due to AI helping manage the administrative burden of thousands of questionnaires by identifying incomplete responses, as well as sorting through submissions based on time sensitivity. However, AI does not make any clinical decisions. All certificates continue to be created individually by GMC registered doctors using their own judgment and discretion to create a clinical led service, as an automated approval process or the use of templates would defeat this purpose.
To support this change, I am reinvesting in our governance framework. We are only using AI to assist with triage and quality assurance. I will still personally review the clinical reasoning behind each refusal and escalation to ensure they comply with the same standards I would enforce in NHS general practice.
What are the 3 things you like best about your work and why?
I enjoy being able to provide a patient with an immediate clinical answer regarding their appointments for fit-to-fly letters and stress leave certificates because it takes away the uncertainty of having to wait weeks to receive an appointment. This is particularly important since patients who need a note for their fit-to-fly letter or leave certificate will often have to schedule a routine appointment with their GP, which could take two weeks to receive. During that time, they could miss out on an opportunity to travel or return to work, as well as filing for insurance.
By reviewing cases from a distance and providing signed PDFs by 9:00 AM on the following day, we are truly fixing the access point for these patients.
What are your greatest 3 skills and how have they helped you succeed?
I have a diverse experience in clinical governance; I have worked in Emergency and Trauma Medicine in South Africa (KZN and Gauteng), ENT Surgery in Switzerland and as a Trainer for GP Registrars in the NHS and on a US-based online platform.
My experience with clinical governance provides me with confidence that I can make rapid safe and defensible decisions without the need to physically examine the patient. Because of this ability I am able to supervise each individual MedCert patient consultation without compromising the high level of service I provide.
To mirror what I would do in a clinical environment I use structured questionnaires, requests for upload of supporting evidence and a clear escalation protocol for further investigation if required.
Tell us about a time where you saw a surprising outcome that you did not expect.
A surprising outcome occurred when a patient requested a certificate of membership cancellation from the gym due to an injury. While reviewing their questionnaire, I found that the language indicated they were severely depressed and possibly considering suicide. Instead of issuing the certificate as requested, I escalated the patient’s case to urgent mental health services and followed up to ensure that the patient was safe.
This situation turned out to be a crisis intervention instead of the administrative task that I expected, which demonstrates how a low-cost online service can provide information about serious problems that may have been missed during a rushed appointment with the NHS.
What is the biggest challenge you face each day and how do you handle it?
The greatest obstacle I encounter daily is the need for clinical rigor while I develop a same-day certificate service to review large numbers of questionnaires submitted via our website. The pressure is always to deliver certificates as quickly as possible, but speed should never take precedence over providing a thorough assessment of a patient who discloses chest pain, expressing suicidal ideation, or requiring urgent intervention due to travel risks.
I address this issue by reviewing personally all patients who meet my flags and by denying any requests for a certificate that I consider to lack sufficient supportive documentation, even though this choice may mean lost revenue and may sometimes result in an unhappy patient. I also employ standardised questionnaires with explicit criteria to escalate cases so that I remain consistent in my clinical judgement during all stages of the review process.
What is a habit you try to stick to and how has it helped you?
I make it a point to set aside 30 minutes per day for the purpose of reading all of the cases that I refuse and escalate, reviewing recent updates to best practices, and checking my clinical governance prior to issuing certificates. I felt this was necessary when I first transitioned into online medicine as there tends to be a significant amount of transactions in the field. This gave me an opportunity to slow down my thinking during the day and do some self-reflection about how I reasoned through cases.
My daily review practice has allowed me to succeed by identifying inconsistencies in documentation before they became an issue, ensuring my documentation would be defensible if I were to ever be called into question about it, and ensuring that the menopause and lifestyle management I provide is supported by the best evidence available as opposed to the customary habits I developed prior to moving into an online practice. Additionally, this practice can provide added protection to patients, as it allows me to look at those cases that I would not have otherwise taken the time to reflect upon and review again prior to signing off on a certificate for that patient.
How do you celebrate your victories?
The way I celebrate my victories is through writing a short Case Reflection on the victory itself and sharing the credit with my team rather than using parties or gifts to reward myself. An example of this is when I received a notification from a patient that they received a Same-Day Fit-To-Fly certificate which enabled them to travel home due to an emergency family situation; after thanking my co-founder, my reviewers and noting what worked for this patient, I updated my Protocol to reflect what had been done correctly.
Celebrating in this manner has proven beneficial to me as it lets me keep my attention on the patient’s outcome and the importance of learning from the victory as opposed to focusing on receiving personal recognition. In addition, by updating the Protocol to reflect a single victory, I have improved the service for the next 100 patients, which is far more significant to me than receiving a temporary reward.
What is your favorite book and why?
Atul Gawande’s “Being Mortal” made a major impact on me by stating that the goal of medicine should be not only to hold onto life but also provide dignity and allow people to function. The principle behind “Being Mortal” greatly influences my practice of medicine as I work with people going through menopause and also those making lifestyle changes. I strive to help people resume sleeping, moving, working, and being themselves.
Gawande’s book also influenced the way I built MedicalCert, because sick notes and fit-to-fly letters are not simply pieces of paper to me; they are my clinical opinion and have the potential to give someone the ability to work, travel, and care for their family. It’s a power I need to approach with humility, as described in Gawande’s book.
If you do charity or volunteer work, what is it and why do you do it?
I worked as a volunteer with the Taiwanese Medical & Dental Association for HIV Prevention, Malaria Eradication Projects in São Tomé and Príncipe, and Basic Medical and Dental Care for Tibetan Refugee Coverage Areas in Southern India. I do this because I saw that most of the suffering in the world resulted from simple and preventable barriers (of access) and not from rare diseases requiring costly technology.
The experience remained with me after transitioning into NHS general practice and later through online medicine. This is why MedicalCert is always available at low flat rate prices, why I refuse to issue certificates that aren’t clinically necessary, and why I still take the time to explain to someone, even if they get a “No” from me.
Who has been your biggest mentor in life (personal or professional) and how have they helped you?
The major mentor for me has been the senior GP trainer who was my supervisor while I was doing my NHS Vocational Training Scheme, as they demonstrated to me how to make safe choices based on incomplete knowledge and how to tell a patient “I don’t know” while still maintaining their confidence in me.
This GP Trainer also taught me by doing complex consultations while thinking out loud and communicating their uncertainty and safety net to their patient in writing, which was not how I was trained to perform as a junior doctor (with total confidence).
The assistance I received in my training by being required to document all decisions was vital to my current role of Medical Director. Without that training, I would not be able to review a remote questionnaire, identify a red flag, and then give either a certificate or escalate to the relevant parties in a clear, defensible manner.
Just for fun, what is your favorite food?
Kale salad