“Doctors have never been shy to issue an honest scientific opinion of their patients to the authorities when required; they are not going to start being shy now.”

Those who are used to reading various foreign newspapers have, over the years, come across situations where authorities of all sorts have thrown suspicion upon doctors’ honest scientific opinion regarding their clients in difficulty. The following discussion is relevant to this dilemma which may be observed, in one way or another, in several countries in distant and relatively recent history.

There was once a concrete and dumb way of reasoning, whereby one should be able to determine if a person is sick just by looking at him. This is not always easy for a doctor to do; but non-doctors sometimes feel the self-conviction of being able to do so through sheer perception and intuitive suspicion – which is emotional rather than scientific or intellectual. But never mind.

An employee with a medical certificate in those times and countries, would receive the visit of a policeman to ascertain that he was at home, as various people unrelated to the medical profession had a certain profound, impeccable capability and competence to determine a person’s health from his presence at home. This was original and primitive medical practice, somehow based on presumptuous guesswork but containing some validity anyway. i.e. the validity of old wives’ tales.

Policemen felt rather uncomfortable and embarrassed at this obligation, but had to obey irrational orders. Thank God, they do question orders sometimes nowadays and I believe that the more intelligent superiors welcome this enthusiasm. They did not feel that this strange task was related to their duties. Police unions and associations nowadays in most countries, make sure that their members are not subjected to this ordeal and ridiculous, carnavalesque practice.

Although people joked about this incredible surreal situation, they wondered if this inquisitorial practice would actually oblige a “medical policeman” to dutifully place his hands on the bed-sheets to see if they were warm or cold. If the person on sick-leave was walking around the house or if he had just lain down on the bed at the policeman’s door-bell ring, the horrible prankster would be caught out and suffer the pain and tribulations of the law – if not the relegation to that burning place resounding with the gnashing of teeth. For medical amateurism of the time judged with self-conceited solemnity, that if you stand up, you are healthy while if you lie down you are sick. If you actually thrust your head out of the window for some fresh air, you are defying the state, mocking the regime and expect to be whipped with what’s coming to you. So there!

 Nowadays we say that it was a comic situation. However, it was tragic rather than comic, for the “medical policeman” who was obliged to stick his metaphorical fingers into the sick person’s bed-sheets – if not closer to the sick person’s metaphorical haemorrhoids, was looked upon as an instrument of the inquisition persecuting a suspicious citizen with inquisitive index fingers – and all the others. 

You may be thinking that these witch hunts of yore have completely disappeared. WRONG! Remnants of the above ambiguous situations remain to some extent nowadays. While most legal persons today are of the brightest confession, some naïve ones holler holily that a sick person must hide and hibernate under the quilt – if not under the bed, and quiver with fever or in apprehension of an impending fiery, eternal damnation. The sick person must be horizontal as, if he dares be perpendicular, he is not sick! If he stands up to go to the loo, he is cheating and mocking the nation, as a sick person must pee, among other things, in bed. Ergo, a sick person must remain horizontal, to make things easy, in preparation for his final trip to the cemetery and one of the other spiritual destinations where medico-legal glaring does not give a damn. If you are not moribund, you are not sick. Case dismissed! So please call in the warder and away with him (the im-patient cheater, not the warder.)

Over the decades, over generations, man’s psychological illnesses have multiplied, especially due to the stresses of modern, artificial lifestyles, where people are condemned if they don’t do everything electronically and thus are hopelessly “primitive”. Ironically, when people were “primitive”, they were healthier! The naïve observer does not understand that psychology and its problems are abstract. For how can a reality be abstract! Sometimes a legal naïve person states, with resounding conviction, that sick means shrieking with pain on a bed or writhing with muscular anguish on the floor. Ergo a person may be legal and troglodytic at the same time. It’s an achievement.

 I have seen and heard rare, naïve, legal persons exclaim: “Ha ha! S/he has a medical certificate but was actually seen walking outside, or sitting in his/her garden or having a coffee in a café!” Doctors who actually tell their patients that they cannot possibly stay at home, but must walk around for their mental health, are sometimes inundated with scorn. Some naïve legal persons raise their arms to heaven and thunder: “If a person with a medical certificate does not have an outer appearance of morbid sickness, like an obvious surface of flagellation, maggot eggs and hot fever, he and his doctor must be trying to cheat society, the state, the nation and the universe! Ergo, downright shame!” To the naïve legal person, a phenomenon may be abstract and, at the same time, it can be seen, heard, touched, weighed and smelled. Logic and philosophy have advanced by leaps and bounds and they are now more presumptuous and self-assured. But there is nothing really wrong with legal simplicity; one must start from year one at university and carefully proceed further while never abandoning the philosophy that simplicity is a blessing.

If these things were not absolutely rare, I would suspect that a time would be approaching when doctors could be in serious conflict with their doubters and disbelievers. And inevitably they would contemplate such exasperated measures as referring the situation to the World Health Organisation. Luckily, rational observers and Ministries of Justice worldwide will never let this happen.

Dr Anthony Licari has an academic background of Human Sciences from various French universities.