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Barriers to good sickness certification: an interview study with Swedish general practitioners
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
2008 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 36, no 4, 408-414 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: To date, there is no gold standard for sick-listing practices, and physicians find sickness certification problematic. Measures have been taken to improve physician's sick-listing practices, but with ambiguous results. To be able to make such interventions effective, it is important to identify and target barriers to good practices. Our aim was to identify barriers preventing general practitioners (GPs) from sick-listing in the way they think is best. METHODS: Semi-structured individual interviews were carried out with 19 GPs in 17 primary healthcare centres in four central Swedish counties. Interview transcripts were analysed using qualitative content analysis to identify types of barriers to good sick-listing practices. RESULTS: Barriers within the healthcare system included: complexity of clinical judgements; the physician's competence - especially, poor skills in handling situations regarding conflicting perceptions of the need for sickness certification; the performance of other healthcare professionals; and deficiencies in the healthcare system itself. Barriers outside the healthcare system included: general attitudes to sick-listing and benefits; the labour-market situation; patients' social problems; and the performance of and collaboration with other stakeholders. CONCLUSIONS: GPs experienced a number of barriers to what they perceived to be good sick-listing practice. Such barriers need to be addressed in interventions for change. We propose communication skills training, with a special emphasis on difficult situations in sick-listing practice.

Place, publisher, year, edition, pages
2008. Vol. 36, no 4, 408-414 p.
Keyword [en]
barriers, general practice, physician's practice patterns, primary healthcare, qualitative content analysis, sick-leave, sick-listing; sickness certification
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-97291DOI: 10.1177/1403494808090903ISI: 000257536300010PubMedID: 18539695OAI: oai:DiVA.org:uu-97291DiVA: diva2:172159
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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