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OBJECTIVE: To investigate what factors are associated with physicians' decisions on whether or not to sickness certify the patient at a consultation. DESIGN: Questionnaire survey sent to physicians in general practice and their patients. SETTING: General practitioners in Orebro county, central Sweden. SUBJECTS: Sixty-five physicians with up to 10 patients each. MAIN OUTCOME MEASURE: Whether a sickness certificate was issued. RESULTS: Physicians with long experience in family medicine and those working part time issued more sickness certificates when all encounters with patients were considered. When only musculoskeletal problems were studied physicians with long experience or who were trained in social insurance medicine as undergraduates issued more sickness certificates. When only appointments for infections were studied, part-time physicians issued more sickness certificates. No impact of the physicians' sex on sickness certifying was found.

CONCLUSIONS: Length of professional experience and physicians' working time appear to influence practices in sickness certifying.

Background: The decision to issue sickness certification in Sweden for a patient should be based on the physician's assessment of the reduction of the patient's work capacity due to a disease or injury, not on psychosocial factors, in spite of the fact that they are known as risk factors for sickness absence. The aim of this study was to investigate the influence of medical factors and functioning on sick listing probability. Methods: Four hundred and seventy-four patient-physician consultations, where sick listing could be an option, in general practice in Orebro county, central Sweden, were documented using physician and patient questionnaires. Information sought was the physicians' assessments of causes and consequences of the patients' complaints, potential to recover, diagnoses and prescriptions on sick leave, and the patients' view of their family and work situation and functioning as well as data on the patients' former and present health situation. The outcome measure was whether or not a sickness certificate was issued. Multivariate analyses were performed. Results: Complaints entirely or mainly somatic as assessed by the physician decreased the risk of sick listing, and complaints resulting in severe limitation of occupational work capacity, as assessed by the patient as well as the physician, increased the risk of sick listing, as did appointments for locomotor complaints. The results for patients with infectious diseases or musculoskeletal diseases were partly similar to those for all diseases. Conclusion: The strongest predictors for sickness certification were patient's and GP's assessment of reduced work capacity, with a striking concordance between physician and patient on this assessment. When patient's complaints were judged to be non-somatic the risk of sickness certification was enhanced.

Objective: To investigate associations between patients’ family, leisure time and work related factors and physicians' measure whether or not to sickness certify the patient in connection with the consultation. Design: Questionnaire survey to physicians in general practice and their patients. Setting: General practitioners (GPs) and their patients in Örebro county, Sweden. Subjects: 474 patient-physician consultations from 65 physicians with up to ten patients each. Main outcome measure: Whether or not a sickness certificate was issued. Results: Among work related factors, high ‘authority over decisions’ and high "social support" correlated with 30% or more reduced sickness certification probability. Worrying about becoming ill or being injured from work correlates to almost doubled sickness certification risk. Among family and leisure time variables, only living with a common law partner and having no children correlated to increased sickness certification risk. In addition to analyses of the whole group (all diagnoses), the two largest diagnostic subgroups, infectious diseases and musculoskeletal diseases, were examined. For the infectious diseases subgroup, high demands in work correlated to increased sickness certification risk, while in the musculoskeletal diseases subgroup, worry about work related injury or illness was the main factor correlating to increased risk for sickness certification. Conclusions: Work related factors were the most important factors related to sickness certification in this study. Determinants for sickness certification risk differed between diagnostic subgroups.

Aim: The aim of this study was to evaluate the influence of patients’ and physicians’ opinions and attitudes towards health related and insurance system related matters on sickness certification in primary health care.

Methods: 474 patient-physician consultations in general practice in Örebro county, central Sweden, in which sickness certification was an option were documented using physician and patient questionnaires. The outcome measure was whether or not a sickness certificate was issued. Possible determinants were variables indicating the patient’s and the physician’s extent of agreement with statements concerning health and social insurance matters.

Results: GPs and their patients took a fairly similar view to the statements. After multivariate analysis, attitudes expressed by the GPs’ were significantly more frequently related to their decision to sick certify or not, than were patients’ attitudes on the same items. The variables with the strongest impact were found when GPs expressed confidence in physicians’ knowledge of working life and when patients’ gave credit to employers’ willingness to keep disabled people in work. Such attitudes were in general associated with less sickness certification. Patients with musculoskeletal diseases, having met a GP who meant that patients should be allowed sick leave when not mentally well, were more often sick certified.

Conclusions: Opinions among GPs and patients influence on sickness certification risk in several ways. GPs’ opinions seem to have a greater impact than patients’ on the GPs’ decision to sick certify a patient or not.