"Refusal note" - KNMG

You have been told by your treating doctor that he/she will not issue a: 'medical certificate'. In doing so, your doctor has acted in accordance with the rules laid down by the KNMG, the professional organisation for doctors. For more information, see also this page from the KNMG.

In brief, an explanation of these rules

The KNMG's position is that an attending physician should not issue statements about one's own patient in which he/she gives an opinion about a patient's (medical) fitness or unfitness to do or not do certain things. Examples include: is someone able to work, drive a car, go to school, take good care of the children, is a booked trip cancelled rightly, or is someone entitled to a parking permit or adapted housing?

Such certificates may only be issued by an independent doctor (i.e. not your 'own' doctor). Such a doctor can make his or her own assessment of your situation. If necessary, with your consent, that doctor may also request additional information from your treating doctor(s).

The two main reasons for this position are:
The KNMG believes it is important that the treating doctor can concentrate on your treatment and build a good relationship of trust with you. Your doctor should then not get into all kinds of conflicts of interest. To prevent this, there should be a sharp boundary between treatment and assessing whether you can qualify for certain facilities. In this way, nothing prevents you from giving your doctor all the information necessary for your treatment.

In addition, your treating doctor is often unaware of the criteria used to allocate or not allocate certain facilities. This often makes it impossible to give a proper opinion. It is also in your interest that the doctor issuing the medical certificate is well aware of which points are and are not important in the assessment.

So what does this mean in practice?

If you declare that you are ill, the authority requesting a declaration must believe it. In principle, this should be sufficient. If the asking body does not believe you, that body must appoint an independent doctor (not a practitioner) to assess whether your story is true. The assessing doctor should then examine you (possibly only with written questions). Sometimes that assessing doctor, usually called a medical adviser, needs information from your treating doctor. The assessing doctor (i.e. not the authority) may then (with your consent) request information from your treating doctor (e.g. your GP). Only factual information may be requested.

What else can you do?

• You may want to check with the authority requesting a medical certificate whether a statement by yourself about your state of health would not suffice, possibly in the form of a questionnaire to be completed.
• You can ask your doctor for a copy of your medical record that contains certain important facts about your health condition (e.g. the result of a walking test, the result of a measurement of your eyesight, etc.) and send it to the authority requesting a medical certificate.
• For the necessary assessment, you may contact a doctor who is not treating you. With your consent, he/she may also request factual information about your health condition from the doctor treating you and include this information in his/her assessment.