Physicians' messages in problematic sickness certification: a narrative analysis of case reports

Abstract

BackgroundMany physicians find sickness certification tasks problematic. There is some knowledge about situations that are experienced as problematic, whereas less is understood about how physicians respond to the problems they face. One way to acquire such knowledge is to consider "reflection-in-action", aspects of which are expressed in the physician's interpretation of the patient's story. The aim of this study was to gain knowledge about the meaning content of case reports about problematic sickness certification. Specifically, we looked for possible messages to the colleagues intended to read the reports.MethodsA narrative approach was used to analyse reports about problematic sickness certification cases that had been written by GPs and occupational health service physicians as part of a sickness insurance course. The analysis included elements from both thematic and structural analysis. Nineteen case reports were used in the actual analysis and 25 in the validation of the results. Main narrative qualities and structural features of the written case reports were explored.ResultsFive types of messages were identified in the case reports, here classified as "a call for help", "a call for understanding", "hidden worries", "in my opinion", and "appearing neutral". In the reports, the physicians tried to achieve neutrality in their writing, and the patients' stories tended to be interpreted within a traditional biomedical framework. In some cases there was an open request for help, in others it was not obvious that the physician had any problems. Overall, the messages were about having problems as such, rather than the specific features of the problems.ConclusionsThe case reports clearly demonstrated different ways of writing about problems that arise during sickness certification, from being neutral and not mentioning the problems to being emotionally involved and asking for help. The general character of the messages suggests that they are also relevant for case reports in problematic areas other than sickness certification. If pertinent relationships can be found between reflection-in-practice and the narrative writing about practice, they will provide an approach to further research concerning consultations perceived as problematic and also to medical education.

Obstetricians/Gynecologists’ Problems in Sickness Certification Consultations: Two Nationwide Surveys

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“…After 2008, several interventions have been undertaken in Sweden, to facilitate physicians' sickness certification practice: foremost educational efforts, that is, courses in insurance medicine and accessibility to expertise in insurance medicine, but also promoting support at an organizational level through, for example, introducing workplace policies at clinical levels for this [10]. Few studies have evaluated the effects of such interventions, and to the best of our knowledge, no study has specifically targeted O/Gs.…”

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“…This preoccupation, in turn, can suppress the empathy needed for an effective healthcare professional and consumer/survivor relationship. In their narrative analysis of physician case reports detailing problems related to certifying a patient's sickness, Engblom, Alexanderson, and Rudebeck (2011) discovered that healthcare professionals' attempts to remain neutral in content and form in their case reports made acknowledgment of the problem at hand less likely (p. 22). Thus the healthcare professional foremost concerned with appearing impartial was more prone to employing unproductive interventions that primarily focused on the illness rather than the individual patient.…”

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“…Les courriers médicaux constituent des éléments indispensables à l'efficacité et à la continuité des soins. Pourtant, une grande variabilité des contenus des courriers médicaux a parfois été constatée [4,5] . Certaines sociétés savantes ont proposé des référentiels permettant d'évaluer et d'améliorer la qualité des courriers [6] et certains organismes officiels ont tenté de préciser le contenu et les objectifs de ces courriers [7] .…”