Employers are increasingly concerned that their staff are missing work and then feigning sickness to avoid being questioned. This trend has been made easy by doctors who sell medical reports commonly known as "rapport medical.”

With the medical report from a clinic, an employee can be off work for up to three days of sick leave. However, this service is being abused by greedy doctors and sly workers.

In an effort investigate the complaints from employers, The New Times, last week, surveyed clinics around the city to find out whether the doctors actually give out medical leaves without check-ups.

Of the seven clinics this reporter visited, five issued medical leaves after negotiating a price.

On arrival at the clinic, one requests to see the doctor in private. Once in the consultation room, all you have to say is that you need a medical leave to submit to your employer because you have been sick.

Once you own up to your tricks then you pay a fee for the service that is usually extended to genuinely sick patients for free after medical check-up and tests inform the doctor that the patient is not in position to report to duty.

"In your case it is not free,” the doctor at a clinic in Remera said, after this reporter confessed to needing the medical leave so as to skip work. 

After negotiations the agreed price was set at Rwf5,000 and after payment, a leave of three days was signed and stamped.

The investigation was also carried out in clinics in Kacyiru near the bus park, in Nyamirambo, Kiyovu, Kanombe and two others in Kimironko. 

The fee for the medical leave ranges between Rwf3,000 and Rwf5,000, depending on one’s negotiations abilities.

The two clinics that declined to issue medical leave without conducting check-ups were Polyclinique du Plateau in Kiyovu and Sabas Clinic in Kanombe. 

The doctors at these clinics said they were not comfortable issuing a leave unless the decision was informed by results from a check-up.

Medical association warns

Equipped with the findings from the survey, we approached the Rwanda Medical Association that regulates the medical practice to gauge their take on the issue.

"This is unethical behavior and we condemn it. A "rapport medical” is only given to sick people, not to those pretending to be sick,” Dr. Stephen Rulisa, the Kigali Representative of RMA said.

He added: "A medical practitioner must be able to qualify why he or she is granting sick leave to an individual. If he does not have the capacity, he should refer the individual to a specialist or to another hospital rather than bending to requests.”

Dr Rulisa, went on to call the behavior of the doctors a "shame” to the profession.

One doctor, who works at a clinic that issued the "fake” medical leave, was contacted and asked whether it is ethical to issue them without a check-up and he responded that they do so to protect themselves.

"If someone says they feel terrible pain in their back, there is no way a doctor can prove otherwise. If you deny them sick leave yet they feel they need it, any complications to their health thereafter may fall back on the doctor,” a doctor at a private clinic in Kimironko said.

However, Dr Theobald Hategekimana, the Director of Kigali Central Teaching Hospital, one of the largest hospitals in the country that also trains medical students, said the practice is a "terrible mistake.”

He added that doctors must never put their signature to any inconclusive document.

"This can cause repercussions to any doctor who is caught in the habit. Any doctor knows that once their signature is on any document, it is taken seriously, so those in the habit should know that they are breaking the rules,” Hategekimana said.

Serious repercussions

He further warned that those involved risk serious repercussions that can adversely affect their medical careers.

"There is no specific law that condemns this particular behavior, but we are all governed by medical ethics which when breached, a doctor can be suspended or in the worst case, be stripped of his medical license,” Hategekimana said.

For the employers, they are left counting losses caused by employees’ absence. Services are delayed, clients are frustrated, or colleagues are over loaded. These are some of the effects of absenteeism in workplaces.

A Human Resource Manager at one of the top banks in the country said she has had to deal with such employees for long.  

The issue affects both private and public institutions and on a larger scale can be detrimental to their overall performance.

Other human resources staff contacted acknowledged that they suspect that their employees feign sickness, however, when they present medical leaves from doctors, there is nothing they can do.

This, they said, leaves the onus on the doctors to act professionally if the habit is to be eliminated.

For private institutions, the human resources staff contacted by The New Times, requested not to have their companies mentioned as it may compromise their image. And, for public institutions, Angelina Muganza, the executive secretary of Rwanda’s Public Service Commission, was not available for comment by press time.

Employees we talked to also agreed that the behavior was unethical, although they cited strict leave procedures at workplaces as a possible cause.

"Many employers have strict regulations regarding leave days, which forces people to feign sickness to be able to rest. Also to blame is plain laziness and doing too many jobs at once. A doctor’s report is the safest way to get leave,” Daniel Gasatura, an Associate with Trust Law Chambers, said.

"However, I think it is completely unethical on both sides, but most especially on the doctor’s side who took oath to uphold the principles of their profession,” he added.