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Sick-listing as a psychosocial work problem: a survey of 3997 Swedish physicians
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine. (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: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 17, no 3, 398-408 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To quantify the extent of emotionally straining sick-listing problems among three categories of physicians and find associations with workplace characteristics. METHODS: A questionnaire was answered by 3997 physicians (response rate: 71%). RESULTS: A larger proportion of physicians at orthopaedic clinics and, in particular, at Primary Health Care Centres (PHCCs), experienced sick-listing problems, compared to physicians at other clinics. Ten percent of PHCC physicians felt threatened by patients, at least once per month, in relation to sickness certification or worried about getting reported to the disciplinary board. PHCC physicians found sick-listing more problematic compared to others (OR 4.9; 95% CI 4.1-6.0). Having a workplace policy on sick-listing was associated with a reduced risk of experiencing several problems (OR 0.5-0.6, P < 0.05). CONCLUSION: The extent and nature of sick-listing problems warrant further concerns, especially in PHCCs. The nature of perceived threats should be elucidated. Developing workplace policies on sick-listing should be encouraged.

Place, publisher, year, edition, pages
2007. Vol. 17, no 3, 398-408 p.
Keyword [en]
Sick leave, Physician’s practice patterns, Sickness certification, Psychosocial work environment, General practice, Primary health care, Orthopaedics
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-97292DOI: 10.1007/s10926-007-9090-3ISI: 000249120600004PubMedID: 17610050OAI: oai:DiVA.org:uu-97292DiVA: diva2:172160
Available from: 2008-05-12 Created: 2008-05-12 Last updated: 2011-01-21Bibliographically 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.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 359
Neurosciences, sick-listing, sickness certification, physician, general practitioner, orthopaedic surgeon, practice-pattern, barriers, phenomenography, Sweden, Neurovetenskap
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
Available from: 2008-05-12 Created: 2008-05-12Bibliographically approved

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