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Views on sick-listing practice among Swedish General Practitioners: A phenomenographic study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. (Family Medicine and Clinical Epidemiology)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. (Family Medicine and Clinical Epidemiology)
2007 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 8, 44- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The number of people on sick-leave started to increase in Sweden and several other European countries towards the end of the 20th century. Physicians play an important role in the sickness insurance system by acting as gate-keepers. Our aim was to explore how General Practitioners (GPs) view their sick-listing commission and sick-listing practice. METHODS: Semi-structured interviews with 19 GPs in 17 Primary Health Care settings in four mid-Sweden counties. Interview transcripts were analysed with phenomenographic approach aiming to uncover the variation in existing views regarding the respondents' sick-listing commission and practice. RESULTS: We found large qualitative differences in the GPs' views on sick-listing. The sick-listing commission was experienced to come either from society or from patients, with no responsibility for societal interests, or as an integration of these two views. All the GPs were aware of a possible conflict between the interests of society and patients. While some expressed feelings of strong conflict, others seemed to have solved the conflict, at least partly, between these two loyalties. Some GPs experienced carrying the full responsibility to decide whether a patient would get monetary sick-leave benefits or not and they were not comfortable with this situation. Views on the physician's and the patient's responsibility in sick-listing and rehabilitation varied from a passive to an empowering role of the physician. GPs expressing a combination of less inclusive views of the different aspects of sick-listing experienced strong conflict and appeared to feel distressed in their sick-listing role. Some GPs described how they had changed from less to more inclusive views. CONCLUSION: The clearer understanding of the different views on sick-listing generated in this study can be used in educational efforts to improve physicians' sick-listing practices, benefiting GPs' work situation as well as their patients' well-being. The GP's role as a gatekeeper in the social security system needs further exploration. Our findings could be used to develop a questionnaire to measure the distribution of different views in a wider population of GPs.

Place, publisher, year, edition, pages
2007. Vol. 8, 44- p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-97289DOI: 10.1186/1471-2296-8-44ISI: 000249593600001PubMedID: 17663793OAI: oai:DiVA.org:uu-97289DiVA: diva2:172157
Available from: 2008-05-12 Created: 2008-05-12 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Physician Sickness Certification Practice focusing on views and barriers among general practitioners and orthopaedic surgeons
Open this publication in new window or tab >>Physician Sickness Certification Practice focusing on views and barriers among general practitioners and orthopaedic surgeons
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

There is no common understanding on what constitutes good sick-listing, a frequent and problematic task for many physicians, especially general practitioners (GPs) and orthopaedic surgeons. Aiming to achieve a deeper understanding of sick-listing practices, 19 GPs (I, III) and 18 orthopaedic surgeons (II) in four counties were interviewed, and data analysed qualitatively for views on good sickness certification and barriers to desired practice. Data from a survey of all 7665 physicians in two counties on emotionally straining problems in sickness certification (IV) was analysed quantitatively.

Some GPs exposed narrow views of sick-listing, where their responsibility was limited to issuing a certificate, while GPs with the most inclusive view had a perspective of the patient’s total life-situation and aimed to help patients shoulder their own responsibility (I). The orthopaedic surgeons´ perceptions of good sick-listing were mainly related to their views on their role in the health-care system. Some perceived their responsibility as confined to the orthopaedic clinic only, while others had the ultimate goal of helping the patient to become well functioning in life with regained work capacity – by means of surgery and proper management of sick-listing (II).

Difficulty handling conflicting opinions was a barrier to good sickness certification for GPs (III), and problematic for about 50% of all physicians and about 80% of GPs (IV). Orthopaedic surgeons’ handling of such situations varied from being directed by the patient, via compromising, to being directed by professional judgement (II). Other barriers included poor stakeholder collaboration (III). GPs with a workplace-policy on sickness certification reported fewer conflicts and less worry of getting reported to the disciplinary board in relation to sick-listing (IV).

Understanding physicians’ underlying views on and barriers to practicing “good sick-listing” can inform efforts to change physician practice. Communications skills training in handling sick-listing situations with conflicting opinions is recommended.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 66 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 359
Keyword
Neurosciences, sick-listing, sickness certification, physician, general practitioner, orthopaedic surgeon, practice-pattern, barriers, phenomenography, Sweden, Neurovetenskap
Identifiers
urn:nbn:se:uu:diva-8880 (URN)978-91-554-7217-7 (ISBN)
Public defence
2008-06-03, Robergsalen, Gamla Lungkliniken, Ing 40, Akademiska Sjukhuset, Uppsala, 09:15
Opponent
Supervisors
Available from: 2008-05-12 Created: 2008-05-12Bibliographically approved

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