Considerations made by the general practitioner when dealing with sick-listing of patients suffering from subjective and composite health complaints

Abstract

(2011) Considerations made by the general practitioner when dealing with sicklisting of patients suffering from subjective and composite health

Primary Healthcare Professionals’ Experiences of the Sick Leave Process: A Focus Group Study in Sweden

“…The most central aspect of physicians' sickness certification tasks is to determine whether a patient has a disease, and to assess the degree to which this disease reduces the patient's functioning and in relation to work demands and work tasks, the patient's ability to work [3]. Our results support previous findings regarding the problems of assessing work ability, especially when clinical findings are missing [9,13,16,5], but also reveal that the presence of psychological, social, or work-related factors aggravate the assessments. The finding that physicians primarily base their assessments on a feeling of trust in the information given by the patient agrees with earlier research [16,21,18].…”

“…Our results support previous findings regarding the problems of assessing work ability, especially when clinical findings are missing [9,13,16,5], but also reveal that the presence of psychological, social, or work-related factors aggravate the assessments. The finding that physicians primarily base their assessments on a feeling of trust in the information given by the patient agrees with earlier research [16,21,18]. In line with a previous study [16], we found that the patient's ability to evoke empathy and describe his or her symptoms and working conditions played an important role in obtaining the sickness certification.…”

“…One of the problems related to sickness certification is the difficulty in handling the dual roles of patient advocate and medical expert for other authorities like social security, where the responsibility to the patient often outweighs that of medical expert [9,8,13,4,11,14]. Physicians have reported assessments of functioning, work ability, and the need for sick leave as being problematic [6,15,4], especially when the patient describes symptoms that are difficult to diagnose and clinical findings are missing [9,5,13,16]. The sickness certification is then based on the patient's description of his or her symptoms and work situation [17][18][19].…”

Health Care Professionals' Reactions to Patient Pain: Impact of Knowledge About Medical Evidence and Psychosocial Influences

“…Research suggests that healthcare practitioners may dislike patients when clear medical evidence for the pain is lacking. 57,62 Further, healthcare providers may have more doubts about the genuineness of the pain symptoms 38,40,43 when pain has no clear medical explanation.…”

“…Attributing lower pain and disability to patients may impact treatment decisions and may lead to inadequate pain management. Nilsen and colleagues 43 found that patients with symptoms for which there was no clear biomedical basis were at risk of not receiving certificates attesting to their being ill. Moreover, healthcare practitioners may be perceived by patients as invalidating their pain complaints, leading to perceived injustice and exacerbating the disability.…”