Sick-listing habits among general practitioners in a Swedish county

Englund, Lars; Svärdsudd, Kurt

doi:10.1080/028134300750018954

Cited by 66 publications

(23 citation statements)

References 10 publications

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“…Our results confirm the finding concerning the working experience but not the age. The effect of the gender of a physician on sick leave prescribing practices is unclear: in most studies male and female physicians prescribed equal amounts of sick leave [1,2,13,15], but variation has also been found [8,9,11]. The variation found in our research was minor and non-significant.…”

Section: Discussioncontrasting

confidence: 58%

“…When sick-listing a patient, the physician is influenced by a number of factors other than purely medical considerations [2,3,8]. Several studies indicate that if a patient initiated the discussion around sickness certification, the physician nearly always sick-listed the patient [4,8-10]. The most important factor for sick-listing was the patient’s way of presenting his or her problem [11].…”

Section: Introductionmentioning

confidence: 99%

“…The effect of physician-related factors and local structural factors on prescribing practices also appears to be ambiguous. Some studies suggest that these factors may influence the length of sick leave [2-4,8,9,11,13-16], but other studies have found no associations [1,2,4,13,15]. …”

Section: Introductionmentioning

confidence: 99%

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Factors affecting sick leave prescribing in occupational health care: a survey based on hypothetical patient cases

Kankaanpää

Putus

Tuominen

2014

BMC Health Serv Res

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BackgroundSeveral studies have shown considerable differences in the way that physicians prescribe sick leave. The aim of this study was to examine the sick leave prescribing practices of occupational health care physicians and factors affecting these practices.MethodsA questionnaire study with 19 hypothetical patient cases was conducted among 356 Finnish occupational health care physicians. The effects of both physician-related and local structural background variables on sick leave prescribing were studied using regression models. Economic consequences of the variation in sick leave prescribing were estimated.ResultsWhen the cases were considered individually, the variation in prescribed sick leave days was relatively small. However, when considered together, variation in prescribing practice became apparent. On average, the overall number of days of sick leave prescribed for the entire group of 19 patient cases was 85.8, varying between 21 and 170 days. The physicians working at a public health center and those with more than 20 years experience as an occupational health physician tended to prescribe more days of sick leave than others. The quartile of physicians who prescribed the fewest days of sick leave would have resulted in mean production losses (17,100 euro, 95% CI 16,400-17,700) that were half those in the quartile with the most days of sick leave (34,800 euro, 95% CI 33,600-35,900).ConclusionsThere was variation in the sick leave prescribing practices of occupational health care physicians. The most significant factor affecting this variation was the health care sector (public, private or employer clinic) employing the physicians. Variation in sick leave prescribing patterns can lead to inequality between patients.

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Section: Discussioncontrasting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

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Factors affecting sick leave prescribing in occupational health care: a survey based on hypothetical patient cases

Kankaanpää

Putus

Tuominen

2014

BMC Health Serv Res

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“…In a recent survey, only 7% of general practitioners (GP) in Sweden and 18% in Norway said they were worried about losing patients if they did not provide a sick-leave certificate (18). However, patients seem to have a strong influence on such assessments: in one Swedish medical audit, a sick-leave certificate was issued in 87% of cases even when the GP did not think it was warranted (19).…”

Section: Explanations For Disagreement In the Work Ability Assessmentsmentioning

confidence: 99%

“…In a survey of all physicians in Sweden, 60% found it difficult to assess a patient's capacity to work and give a prognosis for the duration of a patient's incapacity (19). The same is likely to be true for disability assessments: most physicians do not receive any training in determining work ability (24) and it seems sensible to give medical students some training in sick-leave certification and disability assessment.…”

Section: Implications and Further Researchmentioning

confidence: 99%

Assessing work ability – a cross-sectional study of interrater agreement between disability claimants, treating physicians, and medical experts

Dell-Kuster

Lauper²,

Koehler³

et al. 2014

Scand J Work Environ Health

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Erroneous Impairment Ratings

Brigham¹

2006

AMA Guides® Newsletter

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A nationwide study in 2005 of 2100 cases referred for impairment rating review found 80% to be erroneous, and 89% of these erroneous ratings were higher than appropriate. Among whole person erroneous ratings (839 of 1037 cases critiqued), the original physician's rating averaged 15.5% whole person permanent impairment, but following rerating by physician experts, the corrected rating averaged 5.6%; only 7% of the cases were underrated. All ratings were based on the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fifth Edition. Tables and figures show error rates according to portion of the body affected, expert vs original rating, and other explanatory variables. Two physicians who use the AMA Guides should arrive at similar conclusions about impairment ratings, but most physicians have not received instruction about assessing impairment, disability, or causation and lack an adequate ability to assess these issues. Causation requires a given cause and a given effect that are associated with a reasonable degree of medical probability and also requires documentation with appropriate scientific evidence (not self-reports or historical time frames). Those who prepare and review assessments of impairment should ensure that clinical causation assessments were accurate, that the rating was performed at maximal medical improvement, that examination findings were consistent, and that the individual's normal state was determined.

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Sick-listing habits among general practitioners in a Swedish county

Abstract: Patients appear to have a strong influence on sick-listing practice, and there are important sex differences among GPs in this practice.

Cited by 66 publications

References 10 publications

Factors affecting sick leave prescribing in occupational health care: a survey based on hypothetical patient cases

Factors affecting sick leave prescribing in occupational health care: a survey based on hypothetical patient cases

Assessing work ability – a cross-sectional study of interrater agreement between disability claimants, treating physicians, and medical experts

Erroneous Impairment Ratings

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