Doctors advised to be cautious when asked to declare patients’ fit to run marathons
Doctors are being advised to be cautious and not feel under pressure to act outside of the limits of their competence when asked by patients to declare that they are ‘fit to participate’ in marathons and other sporting events.
This follows a number of enquiries from GPs to the Medical Protection Society (MPS) about whether to sign the ‘fitness to participate’ forms presented by patients prior to training or events, when their clinical knowledge or expertise may be insufficient to deem the patient fit to take part.
A record 253,930 UK applicants registered for a ballot place in the 2017 Virgin Money London Marathon taking place next Sunday (23 April). This is an increase of more than 6,000 on the 2016 event. Around 56 percent of the 2017 applications were also from people who have never run a marathon before. The rise in UK participants in marathons - taking place both in the UK and overseas - means GPs are faced with a growing number of fitness to participate requests.
Furthermore MPS says its members’ concerns are not only around fitness to participate requests for marathons, but for a range of high impact events. These include ‘fat camps’ in the desert, mock hostage situations, or events where a patient must undergo psychological torture. It said a cautious approach was needed, but stressed that there are options.
Dr Pallavi Bradshaw, Senior Medicolegal Adviser at MPS said: “It is encouraging to see more people getting involved in sporting activities and challenges, and raising money for charities. While GPs will not want to dampen that enthusiasm they should remain objective when asked to sign fitness to participate forms. They must be confident that they have sufficient knowledge about the patient and the nature of the event before deciding whether they can assist.
“GP’s may not always have the required expertise to deem the patient fit to take part without risk, and will understandably be worried about the implications of signing such a form. General Medical Council guidance requires a doctor to do their best to ensure reports they write are not misleading, and says they should not undertake assessments beyond their area of clinical competence.
“There are some options where doctors can assist within the limits of their competence. Depending on the wording of any declaration, signing the form with a qualifying statement may be appropriate. The GP would consider the information they have on the patient’s current and past medical history, which may be relevant to the event, and state that there are no known health conditions which render the patient unfit to participate.
“Where a patient’s medical history is not straightforward or they are under the care of a specialist, the GP may wish to obtain advice first or refer the patient to a doctor with expertise in sports medicine.
“There may be occasions where a doctor may decline to assist with completing the form - if it is in a language they do not understand for example. This can be the case when a patient wants to run a marathon in another country.
“Doctors who are presented with a fitness to participate form and are concerned about if and how to complete it, can contact MPS or their Medical Defence Organisation for advice.”
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