When physicians get stuck in sick-listing consultations: A qualitative study of categories of sick-listing dilemmas

Engblom, Monika; Alexanderson, Kristina; Englund, Lars; Norrmén, Gunilla; Rudebeck, Carl Edvard

doi:10.3233/wor-2010-0965

Cited by 17 publications

(18 citation statements)

References 14 publications

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“…This study confirms results from several studies, that sickness certification is experienced as problematic by physicians, especially by GPs [1,4,2-7,9-11,13,16,17,31]. The study also shows that there are differences between countries regarding GPs' experiences of sickness certification.…”

Section: Discussionsupporting

confidence: 90%

General practitioners' experiences with sickness certification: a comparison of survey data from Sweden and Norway

et al. 2012

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BackgroundIn most countries with sickness insurance systems, general practitioners (GPs) play a key role in the sickness-absence process. Previous studies have indicated that GPs experience several tasks and situations related to sickness certification consultations as problematic. The fact that the organization of primary health care and social insurance systems differ between countries may influence both GPs' experiences and certification. The aim of the present study was to gain more knowledge of GPs' experiences of sickness certification, by comparing data from Sweden and Norway, regarding frequencies and aspects of sickness certification found to be problematic.MethodsStatistical analyses of cross-sectional survey data of sickness certification by GPs in Sweden and Norway. In Sweden, all GPs were included, with 3949 (60.6%) responding. In Norway, a representative sample of GPs was included, with 221 (66.5%) responding.ResultsMost GPs reported having consultations involving sickness certification at least once a week; 95% of the GPs in Sweden and 99% of the GPs in Norway. A majority found such tasks problematic; 60% of the GPs in Sweden and 53% in Norway. In a logistic regression, having a higher frequency of sickness certification consultations was associated with a higher risk of experiencing them as problematic, in both countries. A higher rate of GPs in Sweden than in Norway reported meeting patients wanting a sickness certification without a medical reason. GPs in Sweden found it more problematic to discuss the advantages and disadvantages of sick leave with patients and to issue a prolongation of a sick-leave period initiated by another physician. GPs in Norway more often worried that patients would go to another physician if they did not issue a certificate, and a higher proportion of Norwegian GPs found it problematic to handle situations where they and their patient disagreed on the need for sick leave.ConclusionsThe study confirms that many GPs experience sickness absence consultations as problematic. However, there were differences between the two countries in GPs' experiences, which may be linked to differences in social security regulations and the organization of GP services. Possible causes and consequences of national differences should be addressed in future studies.

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Section: Discussionsupporting

confidence: 90%

General practitioners' experiences with sickness certification: a comparison of survey data from Sweden and Norway

et al. 2012

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“…Nevertheless, considering the results of our earlier studies [16,17] of a larger sample of the same material, which used other analytical methods, and also our experiences during the sickness insurance courses, it does not seem that the different clinical backgrounds of the physicians affected the way that they presented problems in the case reports. However, the physicians knew that their texts would be read and discussed by smaller groups of colleagues.…”

Section: Discussionmentioning

confidence: 96%

“…However, a striving for neutrality does not necessarily imply that the problem at hand is not acknowledged, although it does make that possibility less likely. If the physician, also in practice, responds to a problematic situation mainly by appearing neutral, there is a risk that ineffective and disease-oriented measures will be perpetuated [16]. There are links between neutrality beyond reason and medical education.…”

Section: Discussionmentioning

confidence: 99%

“…The case reports used here were written as a pre-assignment for participation in a five-day course designed to help physicians improve their skills in sickness certification [16]. Case reports from ten consecutive courses were used.…”

Section: Methodsmentioning

confidence: 99%

“…In previous qualitative studies [11,16], we identified different categories of dilemmas experienced by physicians in their handling of sickness certification. These difficulties arose under circumstances such as the following: when a patient's problem was judged to be non-medical in character; when there was a discrepancy between the patient's presentation of his/her symptoms and the physician's comprehension of them; when the physician perceived sickness certification per se as harmful.…”

Section: Introductionmentioning

confidence: 99%

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

2011

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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.

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Doctors that “doctor” sickness certificates: cunning intelligence as an ability and possibly a virtue among Swedish GPs

Shutzberg

2020

Med Health Care and Philos

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The relations of power between healthcare-related institutions and the professionals that interact with them are changing. Generally, the institutions are gaining the upper hand. Consequently, the intellectual abilities necessary for professionals to pursue the internal goods of healthcare are changing as well. A concrete case is the struggle over sickness benefits in Sweden, in which the Swedish Social Insurance Agency (SSIA) and physicians are important stakeholders. The SSIA has recently consolidated its power over the sickness certificates that doctors issue for their patients. The result has been a stricter gatekeeping of sickness benefits. In order to combat the inroads made by state institutions into sickness certification, and into the sphere of medical practice, some doctors have developed cunning “techniques” to maximize the chance to have their sickness certificates accepted by the SSIA. This article attempts to demonstrate that cunning intelligence—the ability of the weak to “outsmart” a stronger adversary—plays an important role in the practice of medicine. Cunning intelligence is not merely a defective form of prudence ( phronesis ), nor is it simply an instance of instrumental reason ( techne ), but rather an ability that occupies a distinct place among the intellectual abilities generally ascribed to professionals.

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When physicians get stuck in sick-listing consultations: A qualitative study of categories of sick-listing dilemmas

Cited by 17 publications

References 14 publications

General practitioners' experiences with sickness certification: a comparison of survey data from Sweden and Norway

General practitioners' experiences with sickness certification: a comparison of survey data from Sweden and Norway

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

Doctors that “doctor” sickness certificates: cunning intelligence as an ability and possibly a virtue among Swedish GPs

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