Get A Note From Your Doctor (GANFYD)

Ask GPs to name one thing that really irritates them, and many will answer the Get A Note From Your Doctor (GANFYD) culture.

At first it might appear reasonable to ask your GP to just write a quick letter saying it is alright to do this, or alright to do that. But there are two big reasons why it is not.

The first is the sheer number we get asked to do. If it was just the one every now and again, it wouldn't be a problem. But Dr Phibes is asked to do several every day, and my partners similar numbers. This has real implications on workload, and therefore comes low on a list of priorities. In addition these notes are not part of our work for the NHS, so we charge to do them.

The second is how inappropriate and unnecessary many requests are. One of the more common requests comes from probation officers who ask for a note to verify that their client missed a day in court because they were unwell. It doesn't seem to matter to them that we haven't seen the patient during the course of this illness. The most common "illness" is sickness and diarrhoea on the day in question. Of course I have no way to verify or disprove the claim. So what possible use does a letter from me serve?

This is another example that happened to me only yesterday. I'd received a letter from a physiotherapist asking for me to sign a letter saying it was ok for her to do acupuncture on one of my patients. I phoned her up. The conversation went something like this:

Dr Phibes- You've asked me to sign a letter saying it's ok for you to give acupuncture to my patient.

Physio- That's right.

Dr Phibes- I'm afraid I don't know anything about acupuncture. Under what circumstances would it not be safe?

Physio- Well something like unstable angina.

Dr Phibes- So there are specific medical situations where it is unsafe?

Physio- Yes

Dr Phibes- Well as you know what these are but I don't wouldn't it just be simpler if I sent you a summary of her medical history for you to look at for problems?

Physio- You already sent these details when you referred her to the medical clinic originally.

Dr Phibes- So if you already have enough information to know whether it's safe or not, why do you need a letter from me?

Physio- Because it's what we've been asked to do.


These types of notes are known as buck-passing. I get similar requests from gyms saying that they checked Mr Smith's blood pressure, and it was up, so they now need a note saying that it is ok to use their facilities. I've never visited these gyms, so I don't know how vigorously Mr Smith will be exercising, and whether this would be risky or not. What the gyms are thinking is that should Mr Smith drop down dead while there and I've written a note, they'll be able to say "But Dr Phibes said it was ok".

Another issue is how much Drs charge to do such notes. A comment often heard is "You've charged me £20, but it only took you a few minutes to do." What must be born in mind is that generally the Dr is being asked to accept responsibility for whatever they are signing for. So they are charging for their time and any legal liability.