Exploration of GPs' views and use of the fit note: a qualitative study in primary care

Welsh, Victoria; Mallen, Christian; Wynne‐Jones, Gwenllian; Jinks, Clare

doi:10.3399/bjgp12x641483

Cited by 23 publications

(17 citation statements)

References 12 publications

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“…Telephone interviews have been described as inferior to face-to-face interviews, for fostering rapport and recognising subtleties of communication [ 47 ]. However, they can also help interviewees feel comfortable when talking about sensitive topics within a medical context [ 48 ]. In our study the latter was relevant, since participants opened up about extremely sensitive events.…”

Section: Discussionmentioning

confidence: 99%

Coming back from the edge: a qualitative study of a professional support unit for junior doctors

et al. 2017

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BackgroundIt is known that many trainee doctors around the world experience work satisfaction but also considerable work stress in the training period. Such stress seems to be linked to multiple factors including workload, level of support and growing cultural inculcation into unwillingness to show any personal or professional weakness. In the United Kingdom, junior doctors are qualified medical practitioners who have gained a degree in Medicine and are now working while training to become a specialist (consultant) or a general practitioner. The period of medical training can be particularly stressful for some UK junior doctors, in common with their counterparts in other countries. UK Postgraduate Medical Deaneries provide support for those who need it via Professional Support Units (PSUs); however little is known about the perceptions and experiences of the doctors who access and utilise this support. This study aimed to generate qualitative insight into how the (PSU) provided by one UK Deanery is experienced by the trainees who accessed it. We aimed to investigate whether such experience intersects with the progressive socialisation of trainee doctors into the notion that doctors do not get ill.MethodsThrough in-depth telephone interviews with eight female junior doctors, we explored the benefits and problems associated with using a PSU with reference to the formation of trainee doctors’ professional identities, and conducted a thematic analysis.ResultsThemes identified illustrate the process of accepting, accessing and benefiting from PSU support. These are: Medical identity intact (it will never happen to me); Denial of disrupted medical identity; Being on the edge: accepting help; Role of PSU in ‘recovery’ process; Repaired identity / coming back from the edge; Different ways to be a doctor. The gendered sample occurred simply as it was females who responded to study invitations. Whilst we present some related aspects (such as “manning up” as part of keeping going), analyses of this small sample showed that medical identity as a doctor in training was more salient than a gendered experience of help seeking in this study.ConclusionsThis study highlights the initial reluctance of female junior doctors to seek help from the PSU, as acknowledging their own difficulties spoiled their identity as a competent doctor. However, once engaged with the PSU, the findings exemplify its role in repairing medical identity, by offering different and acceptable ways to be a doctor. We interpret these findings within Goffman’s theoretical framework of stigma conferring a spoiled identity on recipients, and how this may then be repaired. Reducing the stigma attached to initial help-seeking among junior doctors is crucial to increase ease of access to the PSU and to improve the experiences of doctors who encounter challenges during their training.

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Section: Discussionmentioning

confidence: 99%

Coming back from the edge: a qualitative study of a professional support unit for junior doctors

et al. 2017

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“…To try and overcome some of these barriers, the UK Government encouraged GPs to issue injured workers with ‘fit notes’ rather than ‘sick notes’ to emphasise what people can do in the workplace and, thereby, facilitating labour market retention [ 7 ]. Several studies have since shown that there is recognition among UK GPs about the health benefits of work and that the fit note functions as a prompt to facilitate conversations around an earlier return to work [ 36 – 38 ]. The fit note also enables discussion between employees, employers, and GPs about appropriate, timely RTW and reduced sickness absence, which has wider benefits to injured workers, employers, and the economy [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

General practitioners and sickness certification for injury in Australia

et al. 2015

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BackgroundStrong evidence supports an early return to work after injury as a way to improve recovery. In Australia, General Practitioners (GPs) see about 96 % of injured workers, making them the main gatekeepers to workers’ entitlements. Most people with compensable injuries in Australia are certified as “unfit to work” by their GP, with a minority of patients certified for modified work duties. The reasons for this apparent dissonance between evidence and practice remain unexplored. Little is known about the factors that influence GP sickness certification behaviour in Australia. The aim of this study is to describe the factors influencing Australian GPs certification practice through qualitative interviews with four key stakeholders.MethodsFrom September to December 2012, 93 semi-structured interviews were undertaken in Melbourne, Australia. Participants included GPs, injured workers, employers and compensation agents. Data were thematically analysed.ResultsFive themes describing factors influencing GP certification were identified: 1. Divergent stakeholder views about the GP’s role in facilitating return to work; 2. Communication between the four stakeholder groups; 3. Conflict between the stakeholder groups; 4. Allegations of GPs and injured workers misusing the compensation system and 5. The layout and content of the sickness certificate itself.ConclusionBy exploring GP certification practice from the perspectives of four key stakeholders, this study suggests that certification is an administrative and clinical task underpinned by a host of social and systemic factors. The findings highlight opportunities such as practice guideline development and improvements to the sickness certificate itself that may be targeted to improve GP sickness certification behaviour and return to work outcomes in an Australian context.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0307-9) contains supplementary material, which is available to authorized users.

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“…Such a system has been recently introduced in the UK, focusing on patients' ability rather than disability [9]. The introduction of a regulated self-certification system for short-term illness in Ireland may reduce the burden on GPs and create greater patient autonomy.…”

Section: Discussionmentioning

confidence: 99%

Sickness certification difficulties in Ireland--a GP focus group study

Foley

Thorley

Hout

2013

Occupational Medicine

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Background Sickness certification causes problems for general practitioners (GPs). Difficulty with the assessment of capacity to work, conflict with patients and other non-medical factors have been shown to influence GPs' decision-making. Inadequate leadership and management of certification issues add to GPs' difficulties. AimsTo explore problems associated with sickness certification, as part of a larger mixed method research project exploring GPs' experiences and perceptions of sickness certification in Ireland. MethodsA qualitative study in an urban region of Ireland. A focus group of four male and four female GPs explored problems encountered by GPs in certifying sickness absence. Thematic data analysis was used. ResultsThree major themes emerged: perception of the sickness certification system, organization of health care and cultural factors in sickness absence behaviour. Employment structures in public and private sectors and lack of communication with other health care providers and employers were identified as complicating sickness certification. ConclusionsGPs encounter a complexity of issues in sick certification and are dissatisfied with their role in certifying sickness absence. Our results open the debate for policy change and development in Ireland.

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Exploration of GPs' views and use of the fit note: a qualitative study in primary care

Cited by 23 publications

References 12 publications

Coming back from the edge: a qualitative study of a professional support unit for junior doctors

Coming back from the edge: a qualitative study of a professional support unit for junior doctors

General practitioners and sickness certification for injury in Australia

Sickness certification difficulties in Ireland--a GP focus group study

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