I am a bit embarrassed to post this, but will try and do so anyway.
I am a male recent graduate from medical school, and will be working soon in primary care. It it will be more of a corporate type practice, (so quite a number of generally healthy working adults).
In my work setting, if you want to take time off for medical reasons, you need to obtain a medical certificate from a doctor.
I have been told that the clinic has a fairly regular stream of female patients seeking medical leave for menstrual symptoms (usually menstrual cramps), and I have been instructed to issue medical chits judiciously (in other words, beware the malingerers).
My query is how can we best assess if menstrual symptoms are genuine in office practice? At a minimum, I would like to ensure that the patient is actually having her period, So my query here is how can we find evidence of menstrual bleeding in practice; specifically, would we expect tampons to be stained with blood at all times, or is it necessary to do a speculum exam. Can bleeding be intermittent, and if so, would it be possible to find tampons not stained with blood and no blood on pelvic examination.
I would give the patient the benefit of the doubt if she complains of menstrual cramps at her 1st consult, and not do any unnecessary examinations or embarrass her. But a problem may arise especially with repeat visitors who may fake symptoms, (especially just before public holidays in order to get a longer holiday) . If the clinic gets a reputation for providing medical leave too easily, (especially to women who are in the intermenstrual phase of the cycle), this may spread among other clients, encouraging them to turn up with fake symptoms, and also making a bit of a mockery of both the clinic and the doctor.
Edit: The practice is also quite big with multiple corporate contracts and satellite clinics, with most providing after-hours clinic services and some 24-hour services. So its not too difficult for a patient to hop from one clinic to another for a medical note. Medical records have not yet been digitised, so we cannot always access records of visits at other clinics, especially after office-hours.
The specific problem we have however is that the practice has contracts with airlines also, i.e. many of these patients are airline crew. The air stewardesses prefer some flights over others, and they sometimes turn up at the clinic just before their flight (usually after-hours and not uncommonly in the middle of the night) to obtain a note. What this also means is that other aircrew placed on standby have to be activated at short notice.
On a spectrum of mild to severe symptoms, most of the patients will probably be at the mild end (but this is also subjective), walking and talking normally. This post is to seek advice on how to make a quick objective assessment at a given point in time (even though a referral may be required in severe cases)
This is a somewhat long post as I have tried to provide some context, but my specific query is shown in red above.
Any advice would be most appreciated. Thank you.
I am a male recent graduate from medical school, and will be working soon in primary care. It it will be more of a corporate type practice, (so quite a number of generally healthy working adults).
In my work setting, if you want to take time off for medical reasons, you need to obtain a medical certificate from a doctor.
I have been told that the clinic has a fairly regular stream of female patients seeking medical leave for menstrual symptoms (usually menstrual cramps), and I have been instructed to issue medical chits judiciously (in other words, beware the malingerers).
My query is how can we best assess if menstrual symptoms are genuine in office practice? At a minimum, I would like to ensure that the patient is actually having her period, So my query here is how can we find evidence of menstrual bleeding in practice; specifically, would we expect tampons to be stained with blood at all times, or is it necessary to do a speculum exam. Can bleeding be intermittent, and if so, would it be possible to find tampons not stained with blood and no blood on pelvic examination.
I would give the patient the benefit of the doubt if she complains of menstrual cramps at her 1st consult, and not do any unnecessary examinations or embarrass her. But a problem may arise especially with repeat visitors who may fake symptoms, (especially just before public holidays in order to get a longer holiday) . If the clinic gets a reputation for providing medical leave too easily, (especially to women who are in the intermenstrual phase of the cycle), this may spread among other clients, encouraging them to turn up with fake symptoms, and also making a bit of a mockery of both the clinic and the doctor.
Edit: The practice is also quite big with multiple corporate contracts and satellite clinics, with most providing after-hours clinic services and some 24-hour services. So its not too difficult for a patient to hop from one clinic to another for a medical note. Medical records have not yet been digitised, so we cannot always access records of visits at other clinics, especially after office-hours.
The specific problem we have however is that the practice has contracts with airlines also, i.e. many of these patients are airline crew. The air stewardesses prefer some flights over others, and they sometimes turn up at the clinic just before their flight (usually after-hours and not uncommonly in the middle of the night) to obtain a note. What this also means is that other aircrew placed on standby have to be activated at short notice.
On a spectrum of mild to severe symptoms, most of the patients will probably be at the mild end (but this is also subjective), walking and talking normally. This post is to seek advice on how to make a quick objective assessment at a given point in time (even though a referral may be required in severe cases)
This is a somewhat long post as I have tried to provide some context, but my specific query is shown in red above.
Any advice would be most appreciated. Thank you.
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