The medical statement: mandatory in France, Italy and Belgium, much less common in other countries. An annual headache for many participants? Or do we find this not more than normal? And why is there such a thing as a medical certificate?
In Italy, France and Belgium, it is a legal requirement for participants to submit a medical certificate for events with time registration. Organizers are obliged to ask for it, otherwise it is not allowed to admit participants to the gran fondo. The certificate may not be older than a certain time, usually half a year. Usually a UCI licence is also sufficient. For events without time registration that obligation does not exist, but an organisation can decide to do it itself.
Participants often complain that the medical declaration is mainly created so that organisers are free of any liability. That's not entirely justified, because the organisers simply have to comply with the law. If they do not, they are in violation. They risk a fine and may lose their license.
In Belgium, it's sufficient to sign a a statement that you are in good shape and able to ride gran fondo performance tours.
In any case, the organizations in the mentioned countries always ask for a medical certificate or UCI license. If you cannot provide this, you will not receive a starting number. This is non-negotiable. Some organizations will give you a starting number, but will not include you in the results. In which case you're riding the gran fondo as a sportive. The policy differs per organizer.
A medical certificate is and remains a snapshot. Moreover, it is a rather limited snapshot; in many cases the GP does no more than take the blood pressure and listen to the heart for a moment. A full sports examination, with an ECG, is already a lot more solid, but also more expensive, depending on your insurance. It might set you a back 150-200 euros. However, the predictive value of a sports medical examination is many times greater than the "general practitioner's examination". In some countries, general practitioner's associations advise their members not to participate in such examinations. But many do it anyway: it's a matter of supply and demand. The customer is king, but no guarantees will ever be given.
Doing a full sports examination every year may also be a bit of overkill if you are healthy. And why would you go to your GP if the value of it is limited? And make the GP part of a system that mainly benefits organisers? Putting something together yourself has therefore become a popular option. Anyone who can Google "doctor's stamp" and has some Photoshop / Word skills, will have be able to create their own certificate. Or you take an old one and just change the year.
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