Fit for purpose: Tackling the ‘fitness to participate’ question

We live in a health-obsessed society – to run a marathon is becoming a rite of passage. However, these feats of fitness put the body through severe stress and GPs are now frequently asked to sign ‘fitness to participate’ requests but what are the limits of their responsibilities and when should they decline to sign these forms? Medicolegal adviser Pallavi Bradshaw provides her thoughts

A record 253,930 UK applicants registered for a ballot place in the recent 2017 Virgin Money London Marathon – an increase of more than 6,000 on last year’s event. Around 56% of the 2017 applications were from people who had never run a marathon before.

While it is encouraging to see more people getting involved in sporting activities and challenges, and raising money for charities, the rise in UK participants in marathons –both UK and overseas – means GPs are faced with a growing number of ‘fitness to participate’ requests.

Furthermore, requests coming in from patients are not only 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!

The reality for GPs

GPs will not want to dampen a patient’s enthusiasm but many will be worried about the implications of signing a form which confirms their patients are fit to train for or participate in these events. This is entirely understandable – GPs may not always have the required expertise to deem a patient fit to take part without risk. They must be confident they have sufficient knowledge about the patient – and the nature of the event – before deciding whether they can assist.

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.

Within the limits of competence

In practice this means GPs should opt for a cautious, objective approach and not feel under pressure to act outside of the limits of their competence. They can also consider options which would enable them to 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 first wish to obtain further advice or could 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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