RICHARD, one measuring stick might be, in this case, that the doc would be required to report to the employer that a certain employee had a note from her/him that exempted them from working that day - or whatever period of time the doc determined.

I suggest this should be mandatory when the safety and well-being of the patient and anyone else may be affected.

I have read that this person very badly feared that he would never get to be a long-haul pilot with an airline - I guess one has to have a certain number of hours? So he wouldn't even call in sick and destroyed his medical exemption notes.

Dishonest and very sick - not a good combo in any situation and particularly not in this one.