Sick leave assessments of workers with subjective health complaints: a cross-sectional study on differences among physicians working in occupational health care

Abstract

Aims: To obtain more insight into differences in sick leave assessments of workers with subjective health complaints, we studied sick leave assessments among Dutch occupational and insurance physicians, and explored possible determinants for these differences. Methods: A cross-sectional study was conducted among 50 occupational and 43 insurance physicians in the Netherlands. They all assessed sick leave (complete, partial or no) of nine video case vignettes of workers with subjective health complaints and gave their opinion on the complaints, sick leave and health status. Data were analyzed via a multinomial regression approach, using generalized estimating equations in SPSS. Results: Compared to occupational physicians, complete sick leave was less likely to be assessed by insurance physicians (odds ratio 0.74, 95% confidence interval 0.56-0.97). For occupational physicians, psychological diagnoses, private issues and reduced work ability had more influence on the outcome of the sick leave assessment than for insurance physicians. Conclusion: There are differences in sick leave assessments for workers with subjective health complaints between physicians working in the same occupational health system; insurance physicians are stricter in assessing complete sick leave than occupational physicians. These differences may be explained by differences in roles, tasks and perspectives of the physician in occupational health care. ä IMPLICATIONS FOR REHABILITATION Sick leave assessments of workers with subjective health complaints. The current study showed that there are differences between occupational physicians and insurance physicians in sick leave assessments for workers with subjective health complaints. These differences may be based on different perspectives, roles and tasks of physicians. Physicians working in the rehabilitation and occupational health system should be more aware of the impact of these differences on their assessments and advices. Better communication and collaboration between physicians, and more insight into and clarification of the perspectives may result in more agreement between physicians' sick leave assessment and advice towards workers.

Cancer survivors' experiences with conversations about work‐related issues in the hospital setting

“…The frequency of such conversations did not differ by hospital type. As described previously, a relatively low occurrence of conversations about work‐related issues can be expected within the Dutch hospital setting, due to the separation of general and occupational healthcare in the Netherlands 16,18 . To compare, in a study by Söderman et al, 25 80% of Swedish breast CSs reported to have had a conversation about work‐related issues with a healthcare professional in the hospital within one year post surgery.…”

“…In the Netherlands, as in several other countries, general and occupational healthcare are organized in separate systems 16,17 . Whereas general healthcare professionals perform curative healthcare tasks, occupational healthcare professionals mainly provide sick leave assessments and reintegration guidance 18 . The availability and accessibility of hospital‐based work‐related psychosocial cancer care varies per hospital and is often not covered by standard healthcare insurance.…”

“…16,17 Whereas general healthcare professionals perform curative healthcare tasks, occupational healthcare professionals mainly provide sick leave assessments and reintegration guidance. 18 The availability and accessibility of hospital-based work-related psychosocial cancer care varies per hospital and is often not covered by standard healthcare insurance. These shortcomings presumably contribute to a relatively low number of work-related conversations between CSs and healthcare professionals in the Netherlands.…”

What is the effect of independent medical evaluation on days on sickness benefits for long-term sick listed employees in Norway? A pragmatic randomised controlled trial, the NIME-trial

“…This exemplifies the potential need for IMEs in certain vulnerable groups for relevant action in the intersection between healthcare and work life [ 25 ]. Previous research has shown that the larger the distance (i.e., a GP will be close due to frequent contact and an insurance physician will be distant due to rare or no contact) between the patient and the physician, the easier it is to make strict sick leave decisions [ 26 ]. Allowing the IME physician to have the last word would have made the Norwegian IME more like IMEs in other jurisdictions [ 26 ].…”

“…Previous research has shown that the larger the distance (i.e., a GP will be close due to frequent contact and an insurance physician will be distant due to rare or no contact) between the patient and the physician, the easier it is to make strict sick leave decisions [ 26 ]. Allowing the IME physician to have the last word would have made the Norwegian IME more like IMEs in other jurisdictions [ 26 ]. However, it would also have introduced the most criticized aspect of IMEs, namely letting a physician who does not know the employee, his/ her health problems, and context well, make decisions for vulnerable and marginalized individuals [ 15 , 27 ].…”