“I just need you to sign me off for three months”

A fit note is the GP’s honest clinical OPINION about how a condition affects work — not a patient-dictated entitlement — so signing a three-month total sign-off that the assessment does not support is dishonest and a probity issue, and must be declined. But "declining" is not the consultation: assess the back (confirming the mild, improving, red-flag-free picture grounds the decision), offer the clinically-appropriate alternative ("may be fit with adjustments"/phased return / a short certificate), and — crucially — surface the REAL driver, the hidden agenda of a workplace grievance/disciplinary, money worries and possible genuine work-related stress/low mood, which IS a legitimate, addressable need separate from the unsupported certificate. Offer legitimate help (occupational health, phased return, stress/mood support, union/Citizens Advice signposting). The examinable skill is holding the probity line WITHOUT being defensive, dismissive or confrontational — de-escalating, exploring rather than just refusing, and keeping the therapeutic relationship intact while being honest. On assessment: a mild, mechanical, improving back strain — moving freely, no neurological or red-flag features. There is no clinical basis for a three-month total sign-off; the evidence would support, at most, a short period and/or a phased/adjusted return, not a blanket long certificate.